Primary Pulmonary Hypertension Differential Diagnoses
- Author: Ronald J Oudiz, MD, FACP, FACC, FCCP; Chief Editor: Zab Mosenifar, MD more...
Diagnostic Considerations
Pulmonary vascular disease can be associated with portal hypertension and connective-tissue diseases. Other associations with pulmonary arterial hypertension (PAH) include exposure to anorexigens and likely other alpha-adrenergic stimulants (eg, cocaine, amphetamines) and HIV seropositivity. Other problems to be considered include cor pulmonale, pulmonary embolism, and cardiogenic pulmonary edema.
Go to Cor Pulmonale for more complete information on this topic.
Differential Diagnoses
- Apnea, Sleep
- Cardiomyopathy, Dilated
- Hypothyroidism
- Mitral Stenosis
- Mixed Connective-Tissue Disease
- Portal Hypertension
- Pulmonary Hypertension, Secondary
- Pulmonic Stenosis
- Scleroderma
- Systemic Lupus Erythematosus
DRESDALE DT, SCHULTZ M, MICHTOM RJ. Primary pulmonary hypertension. I. Clinical and hemodynamic study. Am J Med. Dec 1951;11(6):686-705. [Medline].
Soon E, Treacy CM, Toshner MR, et al. Unexplained iron deficiency in idiopathic and heritable pulmonary arterial hypertension. Thorax. Apr 2011;66(4):326-32. [Medline].
Abenhaim L, Moride Y, Brenot F, Rich S, Benichou J, Kurz X, et al. Appetite-suppressant drugs and the risk of primary pulmonary hypertension. International Primary Pulmonary Hypertension Study Group. N Engl J Med. Aug 29 1996;335(9):609-16. [Medline].
Humbert M, Sitbon O, Chaouat A, Bertocchi M, Habib G, Gressin V, et al. Pulmonary arterial hypertension in France: results from a national registry. Am J Respir Crit Care Med. May 1 2006;173(9):1023-30. [Medline].
Yigla M, Kramer MR, Bendayan D, Reisner SA, Solomonov A. Unexplained severe pulmonary hypertension in the elderly: report on 14 patients. Isr Med Assoc J. Feb 2004;6(2):78-81. [Medline].
Barst RJ, Langleben D, Frost A, Horn EM, Oudiz R, Shapiro S, et al. Sitaxsentan therapy for pulmonary arterial hypertension. Am J Respir Crit Care Med. Feb 15 2004;169(4):441-7. [Medline].
Benza RL, Miller DP, Gomberg-Maitland M, et al. Predicting survival in pulmonary arterial hypertension: insights from the Registry to Evaluate Early and Long-Term Pulmonary Arterial Hypertension Disease Management (REVEAL). Circulation. Jul 13 2010;122(2):164-72. [Medline].
[Guideline] McGoon M, Gutterman D, Steen V, Barst R, McCrory DC, Fortin TA, et al. Screening, early detection, and diagnosis of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. Jul 2004;126(1 Suppl):14S-34S. [Medline]. [Full Text].
[Guideline] Rubin LJ. Diagnosis and management of pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. Jul 2004;126(1 Suppl):4S-6S. [Medline].
[Guideline] McLaughlin VV, Archer SL, Badesch DB, Barst RJ, Farber HW, Lindner JR, et al. ACCF/AHA 2009 expert consensus document on pulmonary hypertension: a report of the American College of Cardiology Foundation Task Force on Expert Consensus Documents and the American Heart Association: developed in collaboration with the American College of Chest Physicians, American Thoracic Society, Inc., and the Pulmonary Hypertension Association. Circulation. Apr 28 2009;119(16):2250-94. [Medline]. [Full Text].
Fijalkowska A, Kurzyna M, Torbicki A, Szewczyk G, Florczyk M, Pruszczyk P, et al. Serum N-terminal brain natriuretic peptide as a prognostic parameter in patients with pulmonary hypertension. Chest. May 2006;129(5):1313-21. [Medline].
Tolle JJ, Waxman AB, Van Horn TL, Pappagianopoulos PP, Systrom DM. Exercise-induced pulmonary arterial hypertension. Circulation. Nov 18 2008;118(21):2183-9. [Medline]. [Full Text].
Torbicki A, Kurzyna M, Kuca P, Fijalkowska A, Sikora J, Florczyk M, et al. Detectable serum cardiac troponin T as a marker of poor prognosis among patients with chronic precapillary pulmonary hypertension. Circulation. Aug 19 2003;108(7):844-8. [Medline].
[Guideline] Badesch DB, Abman SH, Ahearn GS, Barst RJ, McCrory DC, Simonneau G, et al. Medical therapy for pulmonary arterial hypertension: ACCP evidence-based clinical practice guidelines. Chest. Jul 2004;126(1 Suppl):35S-62S. [Medline].
[Guideline] Badesch DB, Abman SH, Simonneau G, Rubin LJ, McLaughlin VV. Medical therapy for pulmonary arterial hypertension: updated ACCP evidence-based clinical practice guidelines. Chest. Jun 2007;131(6):1917-28. [Medline].
[Guideline] Galiè N, Hinderliter AL, Torbicki A, Fourme T, Simonneau G, Pulido T, et al. Effects of the oral endothelin-receptor antagonist bosentan on echocardiographic and doppler measures in patients with pulmonary arterial hypertension. J Am Coll Cardiol. Apr 16 2003;41(8):1380-6. [Medline].
Oudiz RJ, Farber HW. Dosing considerations in the use of intravenous prostanoids in pulmonary arterial hypertension: an experience-based review. Am Heart J. Apr 2009;157(4):625-35. [Medline].
Shapiro SM, Oudiz RJ, Cao T, Romano MA, Beckmann XJ, Georgiou D, et al. Primary pulmonary hypertension: improved long-term effects and survival with continuous intravenous epoprostenol infusion. J Am Coll Cardiol. Aug 1997;30(2):343-9. [Medline].
Oudiz RJ, Schilz RJ, Barst RJ, Galié N, Rich S, Rubin LJ, et al. Treprostinil, a prostacyclin analogue, in pulmonary arterial hypertension associated with connective tissue disease. Chest. Aug 2004;126(2):420-7. [Medline].
Simonneau G, Barst RJ, Galie N, Naeije R, Rich S, Bourge RC, et al. Continuous subcutaneous infusion of treprostinil, a prostacyclin analogue, in patients with pulmonary arterial hypertension: a double-blind, randomized, placebo-controlled trial. Am J Respir Crit Care Med. Mar 15 2002;165(6):800-4. [Medline].
Olschewski H, Simonneau G, Galiè N, Higenbottam T, Naeije R, Rubin LJ, et al. Inhaled iloprost for severe pulmonary hypertension. N Engl J Med. Aug 1 2002;347(5):322-9. [Medline].
Rubin LJ, Badesch DB, Barst RJ, Galie N, Black CM, Keogh A, et al. Bosentan therapy for pulmonary arterial hypertension. N Engl J Med. Mar 21 2002;346(12):896-903. [Medline].
[Best Evidence] Galiè N, Olschewski H, Oudiz RJ, Torres F, Frost A, Ghofrani HA, et al. Ambrisentan for the treatment of pulmonary arterial hypertension: results of the ambrisentan in pulmonary arterial hypertension, randomized, double-blind, placebo-controlled, multicenter, efficacy (ARIES) study 1 and 2. Circulation. Jun 10 2008;117(23):3010-9. [Medline].
Oudiz RJ, Galiè N, Olschewski H, Torres F, Frost A, Ghofrani HA, et al. Long-term ambrisentan therapy for the treatment of pulmonary arterial hypertension. J Am Coll Cardiol. Nov 17 2009;54(21):1971-81. [Medline].
[Best Evidence] Simonneau G, Rubin LJ, Galiè N, Barst RJ, Fleming TR, Frost AE, et al. Addition of sildenafil to long-term intravenous epoprostenol therapy in patients with pulmonary arterial hypertension: a randomized trial. Ann Intern Med. Oct 21 2008;149(8):521-30. [Medline].
Galiè N, Brundage BH, Ghofrani HA, Oudiz RJ, Simonneau G, Safdar Z, et al. Tadalafil therapy for pulmonary arterial hypertension. Circulation. Jun 9 2009;119(22):2894-903. [Medline].
Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA, et al. Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT). Eur Heart J. Oct 2009;30(20):2493-537. [Medline].
Roubinian N, Elliott CG, Barnett CF, Blanc PD, Chen J, De Marco T, et al. Effects of Commercial Air Travel on Patients with Pulmonary Hypertension. Chest. Apr 5 2012;[Medline].
de Man FS, Handoko ML, Groepenhoff H, van 't Hul AJ, Abbink J, Koppers RJ, et al. Effects of exercise training in patients with idiopathic pulmonary arterial hypertension. Eur Respir J. Sep 2009;34(3):669-75. [Medline].
Barst RJ, Rubin LJ, McGoon MD, Caldwell EJ, Long WA, Levy PS. Survival in primary pulmonary hypertension with long-term continuous intravenous prostacyclin. Ann Intern Med. Sep 15 1994;121(6):409-15. [Medline].
Wirostko BM, Tressler C, Hwang LJ, Burgess G, Laties AM. Ocular safety of sildenafil citrate when administered chronically for pulmonary arterial hypertension: results from phase III, randomised, double masked, placebo controlled trial and open label extension. BMJ. Feb 21 2012;344:e554. [Medline]. [Full Text].

