Hello Doc,

Pulmonary Hypertension is defined when the PASP [ Pulmonary artery systolic pressure ] is raised beyond 20 to 25 mm of hg.

There are 4 major types of PAH,

1. Idiopathic, no cause known
2. Left heart failure
3. Some lung disorders
4. Thromboembolic disorders in lung

If you find a acute increase in the PASP >70 mm of hg accompanied by hemoptysis, consider it to be related to thromboembolic disorder and will require acute management.

If you find acute increase in PASP>60 to 70 mm of hg, without hemoptysis, think of acute Heart failure which can have high mortality if untreated. Normal PASP is expected to be below 25 mm of hg. If any increase in PASP beyond this value on 2 D Echo needs fluid management. Treat the patient with diuresis and Fluid restriction below 1 litre a day till the PASP doesn’t come back below 30 mm of hg.

Chronic elevation of PASP may indicate chronic obstructive pulmonary disorder or Interstitial lung disease. Need to assess the FEV1/FVC ratio on PFT as a further investigation. Management of such patients is a challenge. Line of treatment can be based on Phuphus snehan and Pranayam to improve the oxygen saturation in blood which can be a prognostic parameter.