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Pulmonary arterial hypertension — SCE Respiratory MCQ

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HardPulmonary Vascular DiseasePulmonary arterial hypertensionSCE Respiratory

A 43-year-old woman has progressive exertional dyspnoea, presyncope and a loud P2. Echocardiography suggests high pulmonary pressures; CT chest and V/Q scan are normal. Right heart catheterisation shows mean pulmonary arterial pressure 34 mmHg, pulmonary artery wedge pressure 9 mmHg and PVR 5 Wood units. What is the most likely diagnosis?

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Correct answer: C — Pre-capillary pulmonary arterial hypertension

RHC confirms pre-capillary pulmonary hypertension with elevated mPAP and PVR but normal wedge pressure, and normal V/Q makes CTEPH less likely. Post-capillary PH would have an elevated wedge pressure. Pulmonary venous occlusive disease is not confirmed by these data and hyperdynamic circulation would not usually raise PVR to this degree.

Reference: ESC/ERS Pulmonary Hypertension Guideline 2022