Diagnostic Algorithm

Following the diagnostic algorithm for dyspnoea

Patients with unexplained dyspnoea (breathlessness), for which common causes have been excluded, may be at risk of having PAH and should have their symptoms investigated until a cause is found.1
Due to the high prevalence of dyspnoea in primary and tertiary care and the large number of possible diagnoses, it can be easy to arrive at common conclusions for the source of dyspnoea without fully exhausting the diagnostic algorithm.1–3 However, it’s important to see a diagnosis through to avoid misdiagnosing rarer diseases.

Up to 50% of patients admitted to acute, tertiary care hospitals are affected by dyspnoea3

Pulmonary hypertension, in particular, appears low down on the list of likely causes of dyspnoea, and is often missed by physicians for many years before a correct diagnosis is made.1,4

Diagnostic algorithm for patients with dyspnoea

Diagnostic algorithm
Diagnostic algorithm for dyspnoea
Adapted from Karnani NG, et al. 2005.1

Assess Suspected PAH with PH Connect

PH Connect is an online tool designed to support Australian healthcare professionals in referring suspected PAH patients to PAH expert centres for diagnosis and treatment. If you have a patient with unexplained dyspnoea or other symptoms that may be indicative of PAH, you can use PH Connect to help build a case for referral to a PAH Designated Centre or gather information that can be helpful in a consultation with a PAH Expert.

PH Connect consists of a short questionnaire designed to help raise the suspicion of PAH. The questionnaire is based on the 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension and the updated guidance from the World Symposium on Pulmonary Hypertension 2018, available here:
  • Galiè N, et al. Eur Heart J 2016; 37:67-119
  • Morrell NW, et al. Eur Respir J 2018; in press
  • Simonneau G, et al. Eur Respir J 2019; 53: 1801913.
References
  1. Karnani NG, et al. Am Fam Physician 2005; 71: 1529–37.
  2. Berliner D, et al. Dtsch Arztebl Int 2016; 113:834¬–45.
  3. Parshall MB, et al. Am J Crit Care Med 2012; 185:435–452.
  4. Strange G, et al. Pulm Circ 2013; 3(1):89–94.
Footnotes
CBC=complete blood count; CT=computed tomography; CPET=cardio-pulmonary exercise test; V/Q=ventilation/perfusion.

Do you need guidance on referring to a PAH specialist?

Complete a short questionnaire to receive instant feedback.

This content is intended for Australian healthcare professionals. For more information on pulmonary hypertension, please contact your healthcare professional.
Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

World Health Organization functional class (WHO-FC) for patients with PH3,5

This system grades PH severity according to the patient’s functional status, by linking symptoms with activity limitations. WHO-FC remains a powerful predictor of outcomes in patients with PAH.

WHO - FC Description
I
Patients with PH in whom there is no limitation of usual physical activity; ordinary physical activity does not cause increased dyspnoea, fatigue, chest pain, or presyncope.
II
Patients with PH who have mild limitation of physical activity. There is no discomfort at rest, but normal physical activity causes increased dyspnoea, fatigue, chest pain, or presyncope.
III
Patients with PH who have a marked limitation of physical activity. There is no discomfort at rest, but less than ordinary activity causes increased dyspnoea, fatigue, chest pain, or presyncope.
IV
Patients with PH who are unable to perform any physical activity at rest and who may have signs of right ventricular failure. Dyspnoea and/or fatigue may be present at rest, and symptoms are increased by almost any physical activity.
Adapted from McGoon M, et al. 2004.5
Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

Icon/Leaving SiteCreated with Sketch.

Leaving website

The information a reader is about to be referred to may not comply with the Australian regulatory requirements. Further information relevant to the Australian environment is available from the Company or via the Product Information.

This website is intended for Australian healthcare professionals only