The Silent Threat: Unmasking Combined Post- and Pre-capillary Pulmonary Hypertension (CpcPH) in an Elderly Patient With Heart Failure With Preserved Ejection Fraction (HFpEF)
Abstract
Pulmonary hypertension (PH) is a progressive disorder associated with substantial morbidity and mortality, and its diagnosis may be delayed in older adults with multiple cardiopulmonary comorbidities because symptoms frequently overlap with more common cardiovascular and pulmonary conditions. Combined post- and pre-capillary pulmonary hypertension (CpcPH) is a severe phenotype characterized by pulmonary vascular remodeling superimposed on elevated left-sided filling pressures and is associated with worse outcomes than isolated post-capillary PH. We report the case of a 77-year-old man with chronic hypoxic respiratory failure, heart failure with preserved ejection fraction (HFpEF), chronic atrial fibrillation, coronary artery disease, and obstructive sleep apnea who presented with progressive exertional dyspnea, syncope, and increasing oxygen requirements. His symptoms were initially attributed to HFpEF and coexisting cardiopulmonary conditions. Serial transthoracic echocardiography demonstrated progressive right ventricular enlargement, worsening right ventricular systolic function, interventricular septal flattening, and progressively increasing right ventricular systolic pressure (RVSP) from 46.6 to 87 mmHg. Right heart catheterization confirmed severe combined post- and pre-capillary pulmonary hypertension with a pulmonary capillary wedge pressure of 16 mmHg and pulmonary vascular resistance of 10.7 Wood units. Comprehensive evaluation excluded alternative causes of…
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