Clinical diagnosis of pulmonary hypertension

There has been an increased recognition of pulmonary hypertension (PH) in clinical practice over the past 30 years. It is likely that this rise in PH diagnoses is attributable to multiple factors, including increased awareness by clinicians, the routine use of diagnostic tools such as Doppler echocardiography, and the availability and marketing of the many PH-specific drugs.1 Although the increased awareness of the disease should be viewed as a favorable development, the unintended consequences include overdiagnosis, misclassification, and at times indiscriminate use of expensive, PH-specific drugs. In this review, we address the epidemiology, prognosis, and updated clinical classification of PH. We then focus on the diagnostic approach to the patient with suspected PH with an emphasis placed on highlighting key pearls for the clinician to consider. Finally, we review an evolving conceptual framework of viewing the pulmonary vasculature and the right ventricle as a single, coupled cardiopulmonary unit.