Transthoracic Echocardiography is used to image the effects of PH on the heart and estimate PAP from continuous wave Doppler measurements. Echocardiography should always be performed when PH is suspected and may be used to infer a diagnosis of PH in patients in whom multiple different echocardiographic measurements are consistent with this diagnosis.  

The probability of PH may then be judged as high, intermediate or low. When interpreted in a clinical context, the echocardiographic result is required to decide the need for Cardiac Catheterization in individual patients. To facilitate and standardize assignment to the level of probability of PH, several additional echocardiographic signs are proposed in addition to criteria based on TRV. 

These signs provide an assessment of the RV size and pressure overload, the pattern of blood flow velocity out of the RV, the diameter of the PA and an estimate of RAP. Their measurement has been defined in recommendations endorsed by the EACVI.  Echocardiography can help detect the cause of suspected or confirmed PH. Two-dimensional, Doppler and contrast examinations can be used to identify CHD. 

High pulmonary blood flow found on pulsed wave Doppler in the absence of a detectable shunt or significant dilatation of proximal PA despite only moderate PH may warrant transoesophageal examination with contrast or cardiac magnetic resonance (CMR) imaging to exclude sinus venous atrial septal defect and/or anomalous pulmonary venous return. 

In cases of suspicion of LV diastolic dysfunction, Doppler echocardiographic signs should be assessed even if their reliability is considered low. RHC should be considered when the diagnosis remains uncertain after non-invasive investigations. 

1. Learning that you have pulmonary hypertension can turn your whole world upside down. Every new patient, when learning that they have PH, responds differently. It’s important to remember that there are no right or wrong reactions. Give yourself the space to feel and respond to your diagnosis without judgment so you can begin to move forward. Before they were diagnosed, most newly diagnosed patients experienced breathlessness and other symptoms of PH. While your diagnosis marks an ending, it also marks a beginning. Finding a PH-treating doctor, getting on PH-specific treatment, making accommodations for PH in your everyday life, and acknowledging your fears and feelings are all parts of a journey that begins now.

Appropriate diagnosis and analysis of the problem are necessary before starting any treatment. Treatment varies by patient, based on the different underlying causes, but generally includes:  

1. Taking medications 
2. Making lifestyle and dietary changes 
3. Having surgery, if necessary 
4. Regular follow up with your PH specialist doctor.

Many different types of medications are available to treat pulmonary hypertension. Treatment choices, such as those listed below, depending on the underlying cause of pulmonary hypertension, how severe the pulmonary hypertension is, how likely it is to progress, and a patient’s drug tolerance.

• Know the names of your medications and how they work. Keep a list with you. 
• Take your medications at the same time every day. If you forget a dose, do not take two doses to make up for the dose you missed. 
• Do not take any over-the-counter drugs unless you ask your doctor or pharmacist first.
• Also, avoid any over-the-counter medications whose labels state that caution is to be used if you have high blood pressure.
• Do not stop taking or change your medications unless you first talk with your doctor.

Dietary changes:

1. Eat foods that are high in nutrients like potassium (e.g., dried fruits, bananas, oranges) and magnesium (e.g., peanuts, tofu, broccoli) and vitamins. 
2. Limit your total daily calories, if necessary, to achieve your ideal body weight. 
3. Limit foods that contain refined sugar, saturated fats, and cholesterol. Eat foods that are high in fibre, including whole grains, beans, fruits, and vegetables. 
4. Reduce your sodium intake: Buy foods that are low in sodium. Choose foods with labels that read "low salt" and "low sodium." Avoid table salt and seasoning salt. 
5. Avoid smoked, cured, salted, and canned meat products. 
6. Avoid fast food and limit prepared foods; they usually have a high sodium content. 
7. Monitor your fluid intake. Cut down the intake of fluids if you have become more short of breath or if you notice swelling.

Call us if you are having problems with:

• Weight gain — 2 pounds in one day or 5 pounds in one week 
• Swelling in your ankles, legs, or abdomen that has become worse 
• Shortness of breath that has become worse, especially if you wake up short of breath Extreme fatigue or decreased tolerance for activity 
• A respiratory infection or a cough that has become worse 
• Fast heart rate (around 120 beats per minute) 
• Episodes of chest pain or discomfort with exertion that are not relieved with rest 
• Difficulty breathing with regular activities or at rest 
• Restlessness, confusion Constant dizziness or lightheadedness 
• Nausea or poor appetite