Pulmonary embolism and pulmonary hypertension: two issues often neglected in cardiology

![Graphic][1] Pulmonary embolism and hypertension are important causes of disability and death in cardiovascular patients. Unfortunately, they often do not receive the attention they deserve, in part because symptoms are similar to those of other more frequent cardiovascular conditions such as acute heart failure and acute coronary syndromes. The European Society of Cardiology (ESC) published guidelines1 in 2008 and more recently also an updated review on the management of acute pulmonary embolism2 as well as guidelines on pulmonary hypertension3 to help clinicians manage this condition. Both manuscripts have been highly cited and downloaded,4 reflecting the needs of practising physicians. One has to also keep in mind that it is not only the acute management of such patients which is of importance, but also their long-term follow-up. The latter is associated with a significant disease burden.5 Thus, this issue comes just at the right time, reporting on novel developments in the treatment of pulmonary embolism and hypertension. In a first truly innovative, but preliminary paper, Nils Kucher from the Inselspital in Bern, Switzerland described the use of ‘ Fixed low-dose ultrasound-assisted catheter-directed thrombolysis for intermediate and high-risk pulmonary embolism ’.6 The author's retrospective analysis included 52 patients of whom 14 had troponin-positive high-risk and 38 intermediate-risk pulmonary embolism treated with i.v. unfractionated heparin and ultrasound-assisted catheter-directed thrombolysis with 10 mg of recombinant tissue plasminogen activator. During the 3-month follow-up, two patients died. Major non-fatal bleeding occurred in another two. Mean pulmonary artery pressure decreased significantly from 37 ± 9 mmHg at baseline to 25 … [1]: /embed/inline-graphic-1.gif