CSANZ-Ed: Exertional breathlessness is one of the commonest symptoms leading to visits to a cardiologist.

Exertional breathlessness is one of the commonest symptoms leading to visits to a cardiologist. Among the myriad of causes of breathlessness, pulmonary hypertension (PH) is important and frequently under-recognised.

Our latest article on this subject was led by Dr Pyi Naing FRACP, published in the Internal Medical Journal (IMJ) (http://dx.doi.org/10.1111/imj.15860), summarises the new WHO definition, where PH is defined as a mean pulmonary artery pressure (mPAP) > 20mmHg. This corresponds to a peak PAP >30mmHg, with this systolic pressure threshold confirmed using the NEDA database.
In order to improve recognition and diagnosis, particularly in remote and rural areas where health care resources are scarce, the article proposes a new and simple method of screening for PH. This is summarised in the figure below, the central illustration of the article. For patients presenting with exertional breathlessness, initial screening for heart and lung disease is recommended, and the result of echocardiography may then indicate the presence of PH. If PH is present, left heart disease needs to be considered and treated if present. Similarly, lung disease needs to be considered and treated if present. Importantly, if left heart or lung disease is not identified despite the presence of PH, further investigation is warranted including referral of appropriate patients to a multidisciplinary PH team.

This simple triage approach may assist, particularly in remote and rural communities, in identifying which patients are most suitable for specialist referral.