Pulmonary hypertension (PH) refers to hemodynamic alterations in the pulmonary circuit with elevated pulmonary arterial pressures resulting in a spectrum of symptoms from shortness of breath to syncope and collapse. It is associated with high morbidity and mortality. A variety of etiologies may cause pulmonary hypertension and are grouped into five categories (group I-V) based on underlying pathologic mechanisms. The elevation in pulmonary arterial pressures eventually results in right ventricular failure. Due to the derangement in physiologic parameters and right ventricular function, these patients do not tolerate severe illnesses and are frequently cared for in intensive care units. Echocardiography plays a pivotal role in managing these patients and guiding treatment decisions. This chapter discusses the common pathologic presentations, difficulties in assessing hemodynamics, atypical cardiac tamponade physiology, and the utility of echocardiography in evaluating acute decompensation and titration of pulmonary arterial vasodilators.