What steps can be taken if you suspect PAH?

The 2022 ESC/ERS Guidelines recommend diagnosing PAH through 2 approaches: referral or stepwise process

Follow the chart below to assist in the potential identification of PAH in your patients.

Diagnostic algorithm for PH from the 2022 ESC/ERS Guidelines‍¹

Adapted from Humbert M, Kovacs G, Hoeper MM, et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2022;43(38):3618-3731. With permission from the European Society of Cardiology and European Respiratory Society.

Risk assessment

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*Warning signs include rapid progression of symptoms, severely reduced exercise capacity, pre-syncope or syncope on mild exertion, signs of right heart failure.

^†History of PE, permanent intravascular devices, inflammatory bowel diseases, essential thrombocythemia, splenectomy, high-dose thyroid hormone replacement, and malignancy.

^‡Lung and heart assessment by specialist as per local practice.

^§As indicated; CT pulmonary angiography recommended if PH suspected.

^‖Includes CTD (especially systemic sclerosis), portal hypertension, HIV infection, and family history of PAH.

ABG=arterial blood gas analysis; BNP=brain natriuretic peptide; CPET=cardiopulmonary exercise testing; CT=computed tomography; CTD=connective tissue disease; CTEPH=chronic thromboembolic pulmonary hypertension; ECG=electrocardiogram; ERS=European Respiratory Society; ESC=European Society of Cardiology; HIV=human immunodeficiency virus; NT-proBNP=N-terminal pro-brain natriuretic peptide; PAH=pulmonary arterial hypertension; PE=pulmonary embolism; PFT=pulmonary function test; PH=pulmonary hypertension.

Reference: 1. Humbert M, Kovacs G, Hoeper MM, et al; ESC/ERS Scientific Document Group. 2022 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS). Eur Heart J. 2022;43(38):3618-3731.

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What steps can be taken if you suspect PAH?

The 2022 ESC/ERS Guidelines recommend diagnosing PAH through 2 approaches: referral or stepwise process

Diagnostic algorithm for PH from the 2022 ESC/ERS Guidelines‍1

Risk assessment

SERAPHIN pivotal trial

Diagnostic algorithm for PH from the 2022 ESC/ERS Guidelines‍¹