REFERRAL GUIDELINES : WHO TO SCREEN

Screening for pulmonary hypertension

Pulmonary hypertension should be considered (and assessed with echocardiogram) in the differential assessment of breathlessness in patients with:

• Connective tissue disease (esp limited cutaneous sclerosis)
• Past history of venous thromboembolism
• Portal hypertension
• HIV
• Hypoxic lung disease (where there is unexplained deterioration or symptoms are excessive)
• Sickle cell disease
• Family history of pulmonary hypertension

Screening is currently recommended for patients at risk for chronic thromboembolic pulmonary hypertension & in patients with connective tissue disease

Screening for PH in connective tissue disease

Echocardiography & pulmonary function tests are recommended annually. Please refer for assessment if:

• PA systolic pressure (PASP) is >40mmHg
• PASP is 30-40mmHg and patient is symptomatic with no other explanation
• Reduced gas transfer (Dlco <50% predicted) with no evidence of lung disease on HRCT
• Strong clinical suspicion of pulmonary hypertension (symptoms & clinical signs) with inability to estimate PA pressure on echo

Screening for PH following PTE

Most patients who have had a submassive / massive PTE should be assessed at 6 months with an echocardiogram. Patients with recurrent events or evidence of persistent clot on imaging studies are at particular risk of developing pulmonary hypertension. Please refer for assessment if:

• Convalescent PA systolic pressure (PASP) is >40mmHg
• Persisting symptoms with evidence of persistent clot on V/Q scan &/or CTPA despite adequate anticoagulation