Pulmonary Hypertension vs. Heart Failure: Key Diagnostic Elements and the Role of Doppler Echocardiogram in Assessing Pulmonary Arterial Pressure and Fatigue

Pulmonary hypertension and heart failure are two clinical conditions that, while they may coexist, present significant differences in their diagnosis and management. Both can manifest with similar symptoms such as fatigue and dyspnea, complicating their differentiation in clinical practice. However, it is crucial to distinguish between them to implement appropriate treatment and improve patient prognosis.

Key Diagnostic Elements

The diagnosis of pulmonary hypertension is based on the measurement of the pulmonary arterial pressure mean, which must be equal to or greater than 25 mm Hg at rest, measured through right heart catheterization. This procedure remains essential for confirming the diagnosis of pulmonary hypertension or pulmonary arterial hypertension (PAH) [1]. Additionally, the Doppler echocardiogram is a fundamental tool in the initial evaluation, allowing for the estimation of the systolic pressure of the pulmonary artery and assessment of right ventricular function [2].

On the other hand, heart failure is characterized by signs of volume overload, such as peripheral edema and pulmonary crackles. The initial evaluation includes a detailed physical examination, chest X-ray, electrocardiogram, and laboratory analysis to identify causes or precipitating factors [3]. The echocardiogram is the diagnostic standard for confirming systolic or diastolic heart failure by evaluating the left ventricular ejection fraction [4].

A common diagnostic challenge is differentiating between pulmonary hypertension due to left heart disease and pulmonary arterial hypertension. In these cases, the pulmonary capillary wedge pressure (PCWP) measured during right heart catheterization can help distinguish between precapillary and postcapillary hypertension [5].

Conclusions

The precise distinction between pulmonary hypertension and heart failure is essential for guiding therapeutic management and improving clinical outcomes. The use of diagnostic tools such as the Doppler echocardiogram and right heart catheterization is crucial for adequate evaluation. Furthermore, understanding the hemodynamic and clinical differences between these conditions can facilitate a more accurate diagnosis and more effective treatment.

Referencias

• [1] Definitions and diagnosis of pulmonary hypertension.
• [2] Pulmonary hypertension in chronic lung diseases.
• [3] Diagnosis and evaluation of heart failure.
• [4] Standardization of adult transthoracic echocardiography reporting.
• [5] Pulmonary Hypertension Due to Left Heart Disease: Diagnosis, Pathophysiology, and Therapy.

Created 6/1/2025