Primitive pulmonary hypertension – diagnostic problems

Introduction: Pulmonary hypertension (PH) is a chronic progressive disorder with frequent acute de-compensation episodes and high mortality. Because of the non-specificity of the symptoms, it is usually diagnosed in late stages, and despite therapeutic advances, the functional limitations and survival of these patients remain low.

Methods: We present the case of a 34-years-old male diabetic patient (ADO treated) with a history of pulmo-nary TB, who is hospitalized with previous polymorphic chest pain and significant weight loss (about 25 kg in 4 months). Clinical examination reveals lip cyanosis (especially in cold) and extremities (Raynaud’s pheno-menon), vesicular murmur with bilateral tightening, Blood pressure=120/80 mmHg, rhythmic cardiac mur-murs, systolic murmur in the pulmonary focus 3/6 de-gree, systolic murmur in the mitral focus – 3/6 degree, systolic murmur in the tricuspid focus – 4/6 degree, the Hartzer sign was also present.

Results: T he results of the investigations initially in-dicated the presence of cardiopulmonary disease, the electrocardiogram evidence showed a right bundle branch block and the cardiac echography was highly suggestive of primitive pulmonary hypertension developed on a cord presenting specific constitutive ele-ments of obstructive hypertrophic cardiomyopathy. However, the patient refused to perform the right car-diac catheterization to confirm the diagnosis of pulmo-nary hypertension and to identify the hemodynamic type. The subsequent pulmonary scintigraphy negates the diagnostic suspicion of pulmonary thromboembo-lism. Therefore the treatment with beta-blocker, anti-coagulant, dihydropyridine calcium channel blocker and statin was initiated and a favorable clinical deve-lopment was established.

Conclusions: Despite the different current therape-utic strategies, pulmonary hypertension is a constant challenge in daily practice due to a reserved prognosis, multiple complications, and high mortality. Pulmonary hypertension has an important impact on the quality of life, and patient management requires regular evaluati-on with a multidisciplinary team.


ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
The Romanian Journal of Cardiology is indexed by:
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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