THE DIAGNOSTIC AND TREATMENT CHALLENGES OF CHRONIC THROMBOEMBOLIC PULMONARY HYPERTENSION IN LOW- AND MIDDLE-INCOME COUNTRIES: CASE SERIES

Abstract

Chronic thromboembolic pulmonary hypertension (CTEPH), a complication of pulmonary embolism, is one of the major causes of right heart failure and death. It is characterised pathologically by organised thromboembolic material and altered vascular remodelling initiated and potentiated by a combination of defective angiogenesis, impaired fibrinolysis and endothelial dysfunction. One of the challenges in the management of CTEPH is making early and accurate diagnosis as well as instituting prompt and appropriate treatment. We report 4 successfully managed cases of CTEPH occurring in 2 elderly males and 2 young females. All the patients were initially managed for cardiovascular disease, and were referred to the respiratory unit after a period of four to eight months due to worsening dyspnoea. The diagnoses were made using a combination of CT angiogram, Doppler sonogram and 2-D echo; and the patients successfully managed medically. Our aim is to highlight the diagnostic and treatment challenges associated with CTEPH in our environment and the need for a high index of suspicion in dyspnoeic patients.