54 yo M with pulmonary hypertension (Clinic Series)

Tyra Fainstad, MD
Yilin Zhang, MD.
Expert review by Peter Leary, MD (UWMC, pulmonary hypertension specialist)



A 54-year-old man is noted to have a 3/6 pan-systolic murmur best heard over the right upper sternal border on a routine annual exam. He has no past medical history and takes no medications. He undergoes an echocardiogram (TTE) and presents for follow-up of the results.

His TTE showed signs of aortic sclerosis without significant stenosis and an estimated pulmonary artery systolic pressure (PASP) of 40 mmHg and mean pulmonary arterial pressure (mPAP) of 30 mmHg. He denies palpitations, shortness of breath, orthopnea, chest pain, leg swelling or significant weight gain. His vital signs were normal and the remainder of his cardiopulmonary exam is unremarkable.

What is normal range for pulmonary pressures? 

How do estimates of pulmonary pressures from a TTE compare to those determined by right heart catheterization (RHC)? 

Does he need a RHC? 

What is your differential for causes of PH? 


You obtain a 6 min walk (he does not desaturate) and an EKG (normal). What is the next step? 

What therapy can you recommend to the patient while he is waiting for a Pulmonary appointment? Would you diurese him?


What is his prognosis? What factors are associated with a poor prognosis?

How will you counsel him about end-of-life planning?  (optional, ~5 min) 



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