I have post-capillary with some pre-capillary disease as well. As for now, I was told the PAH meds would be high risk for me. I do go to a dedicated PH center.

Thanks for reporting back. Feel good.

Here's what I found out in going back to my MD on my last check which might help others like me in the "combined" post-capillary PH group. Although PAH meds are not used for isolated Group 2 PH because increasing the vasodilation in the lung vessels returns more blood to an already stressed heart, people with combined type PH have pulmonary vessel changes similar to the PAH group, and at some point, the advantages of the PAH meds outweigh their risks so they may be cautiously trialed. He also told me that (a), I'm not there yet, and (b) doing this trial would be out of scope for him, as he works with a lot of PH patients, but he would really want me in a formal PAH center for that. So something to watch for in the future. I was hoping that he might consider them now as my dizziness/syncope is getting really annoying, but I don't want to worsen my cardiac status either.

Here's a cut and paste:

The transpulmonary pressure gradient (TPG), defined by the difference between mean pulmonary arterial pressure (P(pa)) and left atrial pressure (P(la); commonly estimated by pulmonary capillary wedge pressure: P(pcw)) has been recommended for the detection of intrinsic pulmonary vascular disease in the left-heart

DPG stands for diastolic pulmonary gradient, which is a measurement used to assess pulmonary vascular changes. It's calculated by subtracting the mean pulmonary capillary wedge pressure (PCWP) from the pulmonary artery diastolic pressure (PADP

The TPG and DPG numbers are somehow tied to the wedge pressure reading but I don't know the formula for its calculation. I know that any wedge pressure reading above 15 is considered to be Group 2. If the patient has a history of heart issues, and has a Wedge reading of 14 or 15, then the physician doing the RHC is recommended to do a Fluid Challenge that will more accurately determine if the patient is Group 2 or not. My Wedge pressure was measured as 14 but with my history of bi-heart failure, I was given a Fluid Challenge during my last RHC which drove my wedge pressure number up to 28.

BUT...if you are Group 2, you should not be given PAH (Group 1) medications. Medications like Opsumit or Adempas, etc can be dangerous and actually cause complete heart failure. Winrevair is in Phase 3 clinical trials now for Group 2 but is not approved yet. If it does get approved, that will be the first PAH medication that can be given to Group 2 patients.

I am on Furosemide (Lasix), Jardiance and Carvedilol to treat my heart failure (congestive heart disease).