Cynthia L. Bone-larson, MD, PhD

ABSTRACT: The treatment of pulmonary arterial hypertension(PAH) is directed at the underlying cause, such as diastolicheart failure or chronic thromboembolic disease. Patients withidiopathic PAH or PAH associated with connective-tissue diseasewho have World Health Organization (WHO) functionalclass II or III PAH should receive a trial of oral bosentan, ambrisentan,and/or sildenafil; inhaled iloprost is an alternative oran additive agent. If patients fail to respond to these interventionsor if they have WHO functional class IV PAH, considersubcutaneous or intravenous treprostinil or epoprostenol. Theuse of these latter agents is much more complicated and maybe difficult to initiate in elderly patients. (J Respir Dis. 2008;29(12):468-474)

ABSTRACT: Pulmonary arterial hypertension (PAH) is an increasinglyrecognized cause of dyspnea in elderly patients. Theinitial workup typically includes electrocardiography, chest radiography,echocardiography, and pulmonary function tests. Ifechocardiography shows signs of PAH, the diagnosis should beconfirmed by right heart catheterization. Radiographic evidenceof long-standing PAH includes enlargement of the centralpulmonary arteries with abrupt narrowing of the more distalbranches, giving a "pruned-tree" appearance, and right ventricular(RV) enlargement. The classic radiographic signs of RVenlargement include increased transverse diameter of theheart, elevation of the cardiac border on the posteroanteriorview, and narrowing or loss of the retrosternal airspace on thelateral projection. (J Respir Dis. 2008;29(11):443-450)