Diagnosis and Management of PAH in Special Populations in the UAE

Diagnosis and management of pulmonary hypertension (PH) in special populations, including pregnant women, patients requiring intensive care unit admission, and patients who develop complications such as ascites, pericardial effusion or develop COVID-19 infection, are very challenging. PH is associated with poor outcomes in pregnant women as the haemodynamic changes during pregnancy greatly increase maternal mortality. If PH is suspected in pregnant women, further investigation using transthoracic echocardiography is essential, and confirmation with right heart catheterisation is required. All global guidelines recommend avoidance of pregnancy in patients diagnosed with PAH. However, if the patient becomes pregnant, the risks involved with the continuation of the pregnancy and termination of the pregnancy should be discussed. Intensive care may be required in patients with PH for the management of comorbid conditions and following major surgeries and irrespective of the underlying cause of PH, haemodynamic compromise in these patients leads to right heart failure. The PH expert centre plays an important role in the critical care management of patients with PH. Patients with PH may also develop complications such as ascites and pericardial effusion; if not rapidly recognised and treated, these complications can lead to poor prognosis in affected patients. This chapter aims to provide guidance to healthcare professionals in the clinical decision-making process for the diagnosis and management of PH in special populations.