Cardiovascular Journal of Africa: Vol 30 No 1 (January/February 2019)

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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 1, January/February 2019 AFRICA 61
A diagnostic algorithm for pulmonary hypertension due
to left heart disease in resource-limited settings: can
busy clinicians adopt a simple, practical approach?
Anastase Dzudie, Andre Pascal Kengne, Kim Lamont, Bonaventure Suiru Dzekem, Leopold Ndemnge
Aminde, Martin Hongieh Abanda, Friedrich Thienemann, Karen Sliwa
Abstract
Pulmonary hypertension (PH) has progressively moved from
an orphan disease to a significant global health problem with a
major disease burden in limited-resource countries, where over
97% of patients live. The aetiologies of PH differ between high-
and low-income nations, but PH due to left heart disease is
credited to be the most frequent contemporary form. Although
a straightforward diagnosis of PH requires the use of right
heart catheterisation (RHC), access to equipment for RHC is
a deterrent. Furthermore, the risk associated with RHC limits
its uptake to a selection of specialised centres. Moreover, the
rigour and clinical reasoning for diagnosis in clinical medicine
is rapidly changing and revealing that PH can complicate a
diverse range of medical conditions needing other explora-
tions. In this article, we provide for the busy clinician, a simpli-
fied diagnostic algorithm for PH that is relevant for making a
correct early diagnosis and limiting the impact of PH.
Keywords: pulmonary hypertension, diagnostic algorithm, left
heart disease
Submitted 8/4/17, accepted 21/7/18
Published online 30/11/18
Cardiovasc J Afr 2019; 30: 61–67
DOI: 10.5830/CVJA-2018-042
Pulmonary hypertension (PH) is an elevation of the pressure in
the arteries of the lungs, resulting from a variable combination
of increased pulmonary vascular resistance, pulmonary blood
flow and pulmonary venous pressure.1 This definition applies
irrespective of the underlying aetiology of PH, which includes a
range of medical conditions such as chronic infectious diseases,
and lung and left heart diseases. Pulmonary arterial hypertension
(PAH), a specific type of PH, exclusively affects the pulmonary
arterial circulation, resulting in increased pulmonary vascular
resistance, and ultimately in right heart failure (HF) and reduced
life expectancy.
Over the last century, significant progress in the diagnosis and
management of PH has moved this condition from an orphan
disease to a multidisciplinary and now acknowledged major
global health problem. In 2010, it was estimated that PH affects
more than 25 million individuals worldwide.2,3 The ultimate
diagnosis is still based on right heart catheterisation (RHC).
Review Article
Department of Internal Medicine and Department of
Physiology, Faculty of Medicine, University of Yaoundé,
Yaoundé, Cameroon; and Soweto Cardiovascular Research
Unit, University of the Witwatersrand, Johannesburg, South
Africa
Anastase Dzudie, MD, PhD, FESC
Clinical Research Education Networking and Consultancy,
and Cardiology Unit, Douala General Hospital, Douala,
Cameroon
Anastase Dzudie, MD, PhD, FESC,
Bonaventure Suiru Dzekem, MD,
Leopold Ndemnge Aminde, MD
Martin Hongieh Abanda, MD
NIH Millennium Fogarty Chronic Disease Leadership
Program, Stanford, USA
Anastase Dzudie, MD, PhD, FESC
Kim Lamont, PhD
Non-communicable Diseases Unit, South African Medical
Research Council, Cape Town, South Africa
Andre Pascal Kengne, MD, PhD
Faculty of Medicine and Biomedical Sciences, School of
Public Health, University of Queensland, Brisbane, Australia
Leopold Ndemnge Aminde, MD
Clinical Infectious Diseases Research Initiative, Institute
of Infectious Diseases and Molecular Medicine, Faculty
of Health Science, University of Cape Town, Cape Town,
South Africa; and Department of Internal Medicine,
University Hospital of Zurich, Switzerland
Friedrich Thienemann, MD
Hatter Institute for Cardiovascular Research in Africa, South
African Medical Research Council Cape Heart Centre,
IDM, Department of Medicine, Faculty of Health Sciences,
University of Cape Town, Cape Town, South Africa
Karen Sliwa, MD, PhD, FESC