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2022

ESC/ERS 2022 Guidelines — Pulmonary Hypertension

2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension

The 2022 guideline lowered the haemodynamic threshold — a mean pulmonary artery pressure above 20 mmHg, with pulmonary vascular resistance above 2 Wood units defining the precapillary component. Questions frequently hand you a full catheterisation data set and ask you to classify before treating, because the classification determines whether targeted therapy is indicated at all.

That is the single most productive theme here. Drugs approved for pulmonary arterial hypertension are not for pulmonary hypertension due to left heart disease, and specific agents are contraindicated in the lung disease group. A question that offers a plausible vasodilator for a patient with a raised wedge pressure is testing group assignment, not pharmacology.

The rest: risk stratification at diagnosis and at follow-up, the escalation that follows from an intermediate or high risk category, combination therapy and its sequence, chronic thromboembolic disease and its surgical and interventional options, and the paediatric and pregnancy recommendations.

What is in the bank

184 active questions. Class and level follow the recommendation each question is built from.

Class of recommendation

Class I
115
Class IIa
30
Class IIb
21
Class III
18

Level of evidence

Level A
8
Level B
47
Level C
129

Sample questions

Pulmonary hypertension · 2022Class IIILevel A
A 71-year-old woman with long-standing hypertension and heart failure with preserved ejection fraction has worsening breathlessness in functional class III. Echocardiography shows left atrial enlargement with a volume index of 48 mL/m², grade 2 diastolic dysfunction and an ejection fraction of 58%, with an estimated systolic pulmonary artery pressure of 58 mmHg. Right heart catheterization shows a mean pulmonary artery pressure of 38 mmHg, a wedge pressure of 22 mmHg and a pulmonary vascular resistance of 2.5 Wood units, so this is isolated post-capillary pulmonary hypertension. She has bilateral pitting oedema and is five kilograms above her recorded dry weight, her diuretic dose has not changed in two years, and her blood pressure today is 168/88 mmHg. What should be done?
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