Management of heart failure with pulmonary hypertension

Heart failure (HF) and pulmonary hypertension (PH) coexist frequently and contribute to each other. Because PH often is an insidious disease, the cornerstone of management is the early identification and treatment of its underlying causes, such as left-sided heart disease, left to right shunts, and pulmonary disorders. A practical clinical classification has been proposed by the Third World Symposium on Pulmonary Arterial Hypertension for the purpose of diagnosis and treatment of PH. Thromboembolic pulmonary hypertension should always be considered. Recent studies using vasodilators such as prostacyclins and endothelin antagonists give new hope in the otherwise poor prognosis of idiopathic pulmonary arterial hypertension and its related conditions. Despite optimum medical management, transplantation (lung/heart-lung) remains the choice in severely symptomatic patients.