Pulmonary Hypertension

Pulmonary hypertension is a haemodynamic state, not a single disease. The first clinical question is whether the pressure elevation is confirmed; the second is what caused it. That distinction matters because pulmonary arterial hypertension may benefit from targeted vasodilator therapy, whereas the same drugs can worsen pulmonary congestion in left-heart disease and are not routine treatment for lung-disease-associated pulmonary hypertension. The pressure burden eventually reaches the right ventricle. A patient may initially report only exertional breathlessness, but exertional presyncope or syncope, rising jugular venous pressure, ascites, or refractory oedema signals that right-ventricular output is failing. Suspected PAH, CTEPH, or acute decompensation warrants assessment through a pulmonary hypertension expert centre. Canadian practice uses current ESC/ERS and World Symposium definitions and treatment algorithms; the 2020 CCS/CTS statement remains a Canadian pathway reference but predates those updates.