Diagnosis of
pulmonary hypertension requires a laborious investigation that must be performed in accordance with international guidelines. Right-heart catheterization is the gold standard examination to assess the degree of hemodynamic impairment of post- or precapillary origin, guiding management. The presence of comorbidities is becoming rather frequent in real-life
pulmonary hypertension cases, thus creating diagnostic and therapeutic complexity. We present a case of combined post- and precapillary
pulmonary hypertension in a patient with
ischemic heart disease and combined
pulmonary fibrosis and
emphysema, in order to describe the diagnostic algorithm for
pulmonary hypertension and elucidate the problematic aspects of managing this debilitating disease in a patient with several comorbidities. Current guidelines do not support the use of specific
vasodilator treatment in group II - due to
heart disease and group III-due to
lung disease pulmonary hypertension, unless the patient presents with severe
pulmonary hypertension (mean pulmonary artery pressure > 35 mm Hg or cardiac index < 2.0 L/min) with
right ventricular dysfunction and is treated in an expert center and preferably in the context of a randomized control trial. In the case presented, therapeutic management focused, firstly, on treatment of the underlying heart and
lung disease and, subsequently, on specific vasoactive
therapy, due to severe hemodynamic deterioration.