Pulmonary hypertension: current issues of diagnosis and treatment

Pulmonary hypertension (PH) is the group of diseases characterized by progressive increase of pulmonary vascular resistance leading to right heart failure and premature death of patients. This review represents the modern clinical and functional classifications, diagnostic algorithm with four main steps. The 1st step -PH suspicion- includes the analysis of clinical symptoms, physical examination, screening and occasional findings. The 2nd step - PH diagnosis verification- requires some instrumental methods performance, such as ECG, transthoracic echo, chest X-ray, right heart catheterization with acute pharmacological testing. The 3rd step means clinical class determination on the basis of lung function tests, ventilation-perfusion scan, CT and angiopulmonography. The 4th step task is PH type clarification (lab and functional testing, abdomen ultrasound). The PH treatment has always been a real challenge for physicians. Traditional therapy with calcium channel blockers, anticoagulants diuretics, oxygen often fails to help the patients effectively, to prolong their life, to improve its quality. Lately, on increasing of the number of randomized controlled studies in this field, the situation has been changed greatly. In the clinical practice there used the drugs for the treatment of pulmonary arterial hypertension-endothelin receptors antagonists, prostanoids, phosphodiesterase type 5 inhibitors.