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Pulmonary hypertension

Pulmonary hypertension

Referrers should use this page when referring patients to public adult respiratory and sleep medicine outpatient services for pulmonary hypertension.
Emergency referral
If any of the following are present or suspected, refer the patient to the emergency department or seek emergency medical advice if in a remote region.
  • Acute decompensation (hypoxia or right heart failure) with known pulmonary hypertension
Immediate referral
Orange exclamation mark in triangle: orange alertImmediately contact on-call registrar or service to arrange immediate respiratory assessment (seen within 7 days):
  • Nil

To contact the relevant service, see Clinician Assist WA: Acute Respiratory assessment (external site).
Clinical indications for outpatient referral
If any of these issues are present, refer to outpatient services through the Central Referral Service (CRS).

Symptoms as below in the context of an ECHO suggestive of pulmonary hypertension:

  • Dyspnoea that limits ADLs
  • Exertional dizziness/exertional light-headedness or syncope
  • Chest discomfort or pain
  • Palpitations
  • Fluid retention/oedema
  • Fatigue
  • Cyanosis
Mandatory information

Referrals missing 'mandatory information' with no explanation provided may not be accepted by site. If 'mandatory information' is not included, the explanation must be provided in the body of the referral (e.g. patient unable to access test in regional or remote areas or due to financial reason).

This information is required to inform accurate and timely triage. If unable to attach reports, please include relevant information/findings in the body of the referral and advise where (provider) investigation/imaging was completed.
History
  • Relevant history, onset, duration, and severity of symptoms including dyspnoea
  • Details of any previous:
    • cardiac disease
    • respiratory disease (including history of sleep disordered breathing)
    • venous thromboembolism
    • connective tissues disorders
  • Current medication list and history
  • Any known allergies
  • Smoking/vaping status and history
  • Degree of functional impairment (e.g. impact on exercise tolerance/ADLs/ability to work)
Examination
  • Nil
Investigations 
  • ECHO (full report)
Highly desirable
History
  • Family history
Examination
  • Nil
Investigations
  • Relevant imaging reports (e.g. CT thorax, CTPA, V/Q scan)
  • FBC
  • U&Es
  • LFTs
  • Atrial natriuretic factor (ANF)
  • Extractable nuclear antigen (ENA) results
  • Lung function tests
  • Sleep study
Indicative clinical urgency category

Category 1

Appointment within 30 days

  • Newly diagnosed pulmonary hypertension without known heart or lung disease
  • Known pulmonary hypertension with Grade 3/4 dyspnoea (ADLs affected by dyspnoea)
  • Known pulmonary hypertension with deteriorating functional status over 3 months

Category 2

Appointment within 90 days

  • Known pulmonary hypertension with deteriorating functional status over the past year
  • Known pulmonary hypertension with Grade 1/2 dyspnoea

Category 3

Appointment within 365 days

  •  Stable pulmonary hypertension for specialist opinion
Exclusions
  • Nil
Useful information

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