VHOSPITAL.CLINIC · Differential Diagnosis

Heart Failure vs Pulmonary Hypertension

Clinical comparison — shared symptoms, key differences, distinguishing diagnostic tests, treatment pathways, and when to seek urgent evaluation.

Condition Overview

Condition A

Heart Failure

Heart failure occurs when the heart cannot pump enough blood to meet the body's needs. It is a chronic condition that causes fatigue, shortness of breath, and fluid retention (edema). It requires ongoing medical management.

Condition B

Pulmonary Hypertension

Pulmonary hypertension is elevated pressure in the pulmonary arteries, causing progressive exertional dyspnea, syncope, and right heart failure. It is classified into five groups based on etiology; targeted therapies improve outcomes in pulmonary arterial hypertension.

Shared Symptoms — Why They're Confused

Both conditions present with 6 overlapping symptoms, making clinical differentiation essential.

shortness of breath fatigue chest pain palpitations swelling ankle swelling

Key Clinical Differences

Heart Failure

Dyspnoea, orthopnoea, PND, peripheral oedema
S3 gallop, elevated JVP, basal crackles
Responds to diuretics and vasodilators
BNP markedly elevated

Pulmonary Hypertension

Progressive exertional dyspnoea and right heart failure signs
Loud P2, tricuspid regurgitation murmur
Low mPAP >25 mmHg on right heart catheterisation
May be primary (PAH) or secondary to lung/cardiac disease

Distinguishing Diagnostic Tests

Test	Heart Failure	Pulmonary Hypertension
Echocardiography	Reduced LVEF or diastolic dysfunction; left heart pathology	RV dilatation/hypertrophy, elevated RVSP; normal LV function in PAH
Right heart catheterisation	Elevated PCWP (>15 mmHg) — post-capillary pulmonary hypertension	Elevated mPAP with normal PCWP — pre-capillary PAH
BNP + 6-minute walk test	Elevated BNP; limited by dyspnoea and peripheral oedema	Elevated BNP; walk distance correlates with PAH severity

Treatment Approaches

Heart Failure

•Diuretics, ACEi/ARBs, beta-blockers, MRAs
•Device therapy (CRT, ICD) for eligible patients

Pulmonary Hypertension

•PAH-specific therapies: prostacyclins, endothelin antagonists, PDE5 inhibitors
•Avoid in left heart failure — can worsen pulmonary congestion

When Doctors Consider Each Diagnosis

🔵 Consider Heart Failure when:

→Left-sided symptoms, orthopnoea, S3, elevated PCWP, reduced LVEF

🟢 Consider Pulmonary Hypertension when:

→RV dominance, loud P2, normal LVEF, low PCWP, pre-capillary PH on RHC

Explore Each Condition in Detail

Heart FailureOverview →Pulmonary HypertensionOverview →

Related Clinical Pages

Heart Failure

→Heart Failure — Overview →Heart Failure — Treatment →Heart Failure — Differential Diagnosis →Heart Failure — Prognosis →Heart Failure — Complications →Heart Failure — Evidence

Pulmonary Hypertension

→Pulmonary Hypertension — Overview →Pulmonary Hypertension — Treatment →Pulmonary Hypertension — Differential Diagnosis →Pulmonary Hypertension — Prognosis →Pulmonary Hypertension — Complications

Medical References

Content on this page is informed by evidence-based clinical sources including:

World Health Organization (WHO)Global health guidance and disease classification
National Health Service (NHS)UK clinical guidelines and patient information
National Institute for Health and Care Excellence (NICE)Evidence-based clinical practice guidelines
Centers for Disease Control and Prevention (CDC)US public health data and clinical recommendations
PubMed – NCBIPeer-reviewed biomedical literature and clinical studies
Cochrane LibrarySystematic reviews and meta-analyses in evidence-based medicine

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