Who to refer

Definitely refer

1. All suspected cases of pulmonary arterial hypertension (PAH)
· Idiopathic or familial. 
· Connective tissue disease associated (especially scleroderma, SLE, MCTD).
· Congenital heart disease, pre and post-correction. 
· Portopulmonary hypertension.
· Other associated conditions:– HIV, anorexigen use, sickle cell disease.

2. All suspected cases of chronic thromboembolic pulmonary hypertension.

Consider Referral

In hypoxic lung disease (COPD, interstitial lung disease, sleep disordered breathing) where the pulmonary artery pressure is excessively high (TRPG > 60 mmHg or PASP > 65 mmHg).

Patients with left heart disease where the severity of pulmonary hypertension is thought disproportionate to the left heart problem again typically TRPG > 60 mmHg or PASP > 65 mmHg).

It should be noted that treatment of pulmonary hypertension in these patient groups is not yet established.