Pulmonary hypertension (PH) is a hemodynamic condition characterized by a mean pulmonary artery pressure (mPAP) ≥ 25 mmHg at rest, pulmonary arterial wedge pressure (PAWP) ≤ 15 mmHg, and pulmonary vascular resistance (PVR) > 240 dyn·s·cm⁻⁵. The annual incidence of pulmonary arterial hypertension (PAH) is approximately 3–10 new cases per million adults. It is estimated that the prevalence of pulmonary hypertension in individuals over 65 years of age is around 10%.The aim of this study is to present the case of a female patient with progressive dyspnea in whom PAH remained undiagnosed for a prolonged period.A 74-year-old female patient, M.P., was hospitalized in the Coronary Care Unit of the Clinical Center in Kosovska Mitrovica due to symptoms of shortness of breath, choking, fatigue, leg swelling, and weakness. The admission ECG revealed: sinus rhythm, normal axis, high R wave in V2, ST depression, and negative T waves in leads II, III, aVF, and V4–V5. Echocardiography findings showed right ventricular enlargement (2.9 cm), pulmonary artery dilation (3.3 cm), 1–2+ pulmonary regurgitation, and 3+ tricuspid regurgitation, with a systolic pulmonary artery pressure (SPAP) of up to 126 mmHg. The right ventricle measured 5.3 cm in the 4Ch view, with a TAPSE of 1.8 cm. Right heart catheterization revealed the following pressures: PA 78/34/57 mmHg, RV 74/8/10 mmHg, RA 6/6/7 mmHg, CO 4.3 l/min, and LV 99/10/8 mmHg. Although primary pulmonary hypertension is predominantly a disease of younger individuals, it should also be considered in older patients presenting with progressive dyspnea in the absence of structural heart disease.