Thank you Dr. Caspian Oliai for a great case of symptomatic pulmonary hypertension!

Teaching Points:

–Classification by the World Health Organization (WHO):

• Group 1 – PAH
• Group 2 – PH due to left heart disease
• Group 3 – PH due to chronic lung disease and/or hypoxemia
• Group 4 – Chronic thromboembolic pulmonary hypertension (CTEPH)
• Group 5 – PH due to unclear multifactorial mechanisms

–EKG clues of right ventricular strain: RVH, RAD, S1Q3T3 pattern, atrial arrhythmias, new incomplete RBBB, ST-segment changes and T-wave inversions in the right precordial leads (V1-3) ; repolarization abnormalities

–Patients’ fluid status can be tenuous, and much caution should be taken when administering fluids and/or diuretics