Symptoms of PAH

Patients are asymptomatic in the early stages of PAH, or present with non-specific symptoms that can be mistaken for asthma, chronic heart failure or even depression and lack of fitness.1 Early symptoms, especially dyspnoea, may initially appear innocuous, but progress over time, so it’s important to be vigilant in recognising them early (you may wish to use a symptom questionnaire).2

As the disease progresses, symptoms become more severe and begin to limit normal activities.1 Some patients may experience constant dyspnoea and fatigue so that even simple tasks, such as getting dressed and walking short distances, become difficult.1,3 Unfortunately, PAH is frequently not suspected or detected until this late and highly symptomatic stage.4

The clinical severity of PAH is classified according to World Health Organization functional class (WHO-FC).3,5

Associate Professor Eugene Kotlyar

Key message for PAH referrers

Associate Professor Eugene Kotlyar

Symptoms of PAH

If you see unexplained breathlessness with any of the above symptoms, Suspect PH.

References
  1. Humbert M, et al. Eur Respir Rev 2012; 21(126):306–12.
  2. Suntharalingam J, et al. Clinical Med 2016; 16(2):135–41.
  3. Galiè N, et al. Eur Heart J 2016; 37:67–119.
  4. Hoeper MM and Gibbs JSR. Eur Respir Rev 2014; 23:450–7.
  5. McGoon M, et al. Chest 2004; 126(1 Suppl):14S–34S.
Footnotes
COPD=chronic obstructive pulmonary disease; PAH=pulmonary arterial hypertension.

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

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This content is intended for Australian healthcare professionals. For more information on pulmonary hypertension, please contact your healthcare professional.
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