Guidelines of the Spanish Society of Cardiology for pulmonary thromboembolism and hypertension

Primary pulmonary hypertension is a progressive disease. Most affected pati ents are young and middle-aged women. Etiology is unknown, although a famil ial and genetic factor is present in up to 6% of cases. Endothelial dysfunc tion and abnormalities in calcium channels of smooth muscle fibers are the present pathogenetics theories. Diagnostic tests try to exclude secondary c auses of pulmonary hypertension and to evaluate its severity. Acute vasodil atory test is vital in the selection of treatment. Oral anticoagulation is indicated in all patients. Lung transplant is performed when medical treatm ent is unsuccessful. Atrial septostomy is an alternative and palliative tre atment for selected cases. Chronic thromboembolic pulmonary hypertension is a special form of secondary pulmonary hypertension, clinically undistinguis hable from primary primary hypertension, is of mandatory diagnosis because it can be cured with thromboembolectomy. Pulmonary embolism is common in hospitalised patients. The mortality rate f or pulmonary embolism continues to be high: up to 30% in untreated patients . The accurate detection of pulmonary embolism remains difficult, as pulmon ary embolism can accompany as well as mimic other cardiopulmonary illnesses . Non-invasive diagnostic tests have poor specificity and sensitivity. The D-dimer level and the spiral CT angiography have also been employed as new alternatives and important tools for precise diagnosis of suspected pulmona ry embolism. The standard therapy of pulmonary embolism is intravenous hepa rin for 5 to 10 days in conjunction with oral anticoagulants posteriorly fo r 3 to 6 months. The incidence of deep venous thrombosis, pulmonary embolis m and death due to pulmonary embolism, can be reduced significantly and sho wn clear benefits only by adoption of a prophylactic strategy with low-mole cular-weight-heparins or dextrans in patients at risk.