What are the current guidelines for referring patients with suspected pulmonary hypertension to a specialist?

Referral Guidelines for Suspected Pulmonary Hypertension

Patients with suspected pulmonary hypertension should be referred urgently to a specialist pulmonary hypertension centre, especially if they present with symptoms such as fatigue, limited exercise tolerance, light-headedness, chest pain, dyspnoea on exertion, or syncope. This applies to both children and adults, including those with sickle cell disease, where pulmonary hypertension may be asymptomatic or present with non-specific symptoms.

Referral urgency is heightened if symptoms suggest pulmonary hypertension, and echocardiography is recommended as part of screening, particularly in adults with sickle cell disease every 3–5 years, or earlier if symptoms develop.

In general practice, if pulmonary hypertension is suspected clinically (e.g., signs of cor pulmonale such as peripheral oedema, raised venous pressure, parasternal heave, or loud pulmonary second heart sound), patients should be referred to a respiratory or specialist centre for further assessment and management.

Referral should also be considered when symptoms are disproportionate to lung function findings or when there is diagnostic uncertainty, to confirm diagnosis and optimise therapy.