CHRONIC PULMONARY-EMBOLISM - OFTEN MISDIAGNOSED, DIFFICULT TO TREAT .4.

Chronic thromboembolic pulmonary hypertension with cor pulmonale is an extremely debilitating disease that (1) is more common than generally recognized, (2) is often misdiagnosed, and (3) is difficult to treat. When a patient has persistent exertional dyspnea with no obvious caus e, a ventilation-perfusion, echocardiography, and (if indicated) pulmo nary angiography should be done. Prevention is especially important be cause by the time a patient is symptomatic, the disease is already far advanced and hemodynamic reserves are greatly reduced. Prevention of recurrence mandates lifetime anticoagulation and placement of a vena c ava filter. The only effective treatment is pulmonary endarterectomy, which is being performed at an increasing number of specialty centers across the United States.