Which medical specialty treats pulmonary hypertension?

Medical Specialties for Pulmonary Hypertension Treatment

Pulmonary hypertension should be managed by a multidisciplinary team at specialized centers, primarily led by cardiology and respiratory medicine specialists who have specific expertise in pulmonary hypertension. 1

Core Specialist Team for Pulmonary Hypertension

According to the European Society of Cardiology (ESC) and European Respiratory Society (ERS) guidelines, pulmonary hypertension referral centers should provide care through an interprofessional team that includes:

• Primary specialists:

  • Two consultant physicians (typically from cardiology and/or respiratory medicine) with specific expertise in pulmonary hypertension 1
  • These specialists should have dedicated clinical sessions for outpatients, inpatients, and multidisciplinary team meetings

• Essential supporting specialists:

  • Clinical nurse specialists with PH expertise
  • Radiologists with expertise in pulmonary hypertension imaging
  • Cardiologists or PH physicians with expertise in:
    • Echocardiography
    • Right heart catheterization and vasoreactivity testing 1, 2

Referral Center Requirements

Pulmonary hypertension is best managed at specialized centers that meet specific criteria:

• Patient volume requirements:

  • Adult centers should ideally see at least 200 patients annually (at least 50% with confirmed PAH)
  • Centers should follow at least 50 patients with PAH or CTEPH
  • Centers should receive at least two new referrals monthly with documented PAH or CTEPH 1

• Essential facilities:

  • Specialized PH ward
  • Intensive care unit with relevant expertise
  • Specialist outpatient service
  • Emergency care capabilities
  • Advanced diagnostic capabilities (echocardiography, CT scanning, nuclear scanning, MRI, exercise testing, lung function testing, cardiac catheterization)
  • Access to the full range of PH-specific therapies 1

Networked Specialty Services

Referral centers must establish networks with other specialized services that may not be on the same site:

• Genetics
• Connective tissue disease specialists
• Family planning
• Pulmonary endarterectomy (PEA) specialists
• Lung transplantation teams
• Adult congenital heart disease specialists 1

Management Approach

The management of pulmonary hypertension requires:

• Accurate diagnosis and classification through right heart catheterization, which is essential for confirming diagnosis 2, 3
• Risk stratification into low, intermediate, or high-risk categories to guide therapy decisions 2
• Regular follow-up every 3-6 months for stable patients, with comprehensive assessment of treatment response 2

Special Considerations

• Patients with chronic thromboembolic pulmonary hypertension (CTEPH) require assessment by a multidisciplinary team of experts including at least one experienced PEA surgeon 1
• Early referral to specialized centers is critical, as delayed diagnosis can lead to worse outcomes 4
• Emergency physicians should recognize that patients with pulmonary hypertension may require interventions not readily available in standard emergency departments 5

Pitfalls to Avoid

• Failing to refer patients to specialized centers with PH expertise
• Attempting to manage complex PH patients without the necessary multidisciplinary support
• Delaying diagnosis and appropriate treatment, which can significantly impact outcomes
• Using nonselective vasodilators (including nitrates) in PH patients, which can cause severe systemic hypotension and worsen right ventricular failure 2
• Administering fluid boluses rather than vasopressors/inotropes in patients with right ventricular failure 5

The establishment of pulmonary hypertension care center networks has been shown to improve care quality and outcomes for patients with this complex condition 6.