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Pulmonary Arterial Hypertension — EECC MCQ

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HardPulmonary Vascular DiseasePulmonary Arterial HypertensionEECC

A 40-year-old woman with idiopathic pulmonary arterial hypertension (IPAH) is assessed as intermediate risk on the ESC/ERS risk stratification. Her 6-minute walk distance is 380 m, NT-proBNP is 650 pg/mL, and she has mildly impaired RV function. She is treatment-naive. What is the recommended initial therapy?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: D — Initial combination therapy with an ERA plus a PDE5 inhibitor

Explanation lettering: C = shown as A · D = shown as B · B = shown as C · E = shown as D · A = shown as E

Per the 2022 ESC PH Guidelines, treatment-naive patients with PAH at intermediate risk should receive initial oral combination therapy with an ERA plus a PDE5 inhibitor (Class I, LOE B). This is supported by the AMBITION trial. CCB therapy (A) is only for positive vasoreactivity testing. Sequential monotherapy (B) is less effective. IV epoprostenol (D) is for high-risk patients. Transplant (E) is for patients failing medical therapy.

Reference: ESC (2022): Guidelines on Pulmonary Hypertension