To the Editors:
I read with interest the recent review article by Galiè et al. [1] on the use of combination therapy in pulmonary arterial hypertension (PAH). The authors raised a number of important points, including the use of a goal-oriented approach to combination therapy and the need for regular monitoring in order to achieve optimal results for an individual patient.
In support of this approach, I would like to present the case of a 40-yr-old female, who had complained of progressive dyspnoea on exertion during a third pregnancy, becoming particularly noticeable after delivery in March 2005. Her two previous pregnancies had been uneventful and she had no relevant previous medical history. She was initially diagnosed as suffering from fatigue and post-partum depression in August 2005.
The patient was eventually referred to a cardiologist in October 2005, where she was classified as being in New York Heart Association/World Health Organization Functional Class (NYHA/WHO FC) III, with a resting heart rate of 90 beats·min−1 and right axis deviation on ECG. Transthoracic echo/Doppler showed the right heart to be dilated, with a tricuspid regurgitation velocity of 4.7 m·s−1 (estimated right ventricular systolic pressure 100 mmHg) and no evidence of congenital heart disease.
When the patient was subsequently referred to our specialist centre in November …
