Approach to Evaluation of Patients with Chronic Lung Disease with Possible Pulmonary Hypertension - New
Approach to Evaluation of Patients with Chronic Lung Disease with Possible Pulmonary Hypertension - New
«Flowchart»

Symptoms (dyspnea not explained by lung disease, fluid retention)
Labs (elevated BNP, NTproBNP)
Imaging (CT scan with large PA)

Symptoms (dyspnea not explained by lung disease, fluid retention)
Labs (elevated BNP, NTproBNP)
Imaging (CT scan with large PA)

Symptoms (dyspnea not explained by lung disease, fluid retention)
Labs (elevated BNP, NTproBNP)
Imaging (CT scan with large PA)



Repeat echocardiography as clinically indicated

Repeat echocardiography as clinically indicated

Repeat echocardiography as clinically indicated

Consider referral to a PH expert center

Consider referral to a PH expert center

Consider referral to a PH expert center

Echocardiogram

Echocardiogram

Echocardiogram

PAP >40 mm Hg
RV enlargement/hypertrophy/dysfunction
RA enlargement

PAP >40 mm Hg
RV enlargement/hypertrophy/dysfunction
RA enlargement



PAP >40 mm Hg

PAP <40 mm Hg
RV normal
RA normal

PAP <40 mm Hg
RV normal
RA normal



PAP <40 mm Hg

End

End

End

Diagnosis of CLD-PH most likely

Diagnosis of CLD-PH most likely

Diagnosis of CLD-PH most likely

Treat identified causes of PH

Treat identified causes of PH

Treat identified causes of PH


Evaluation for all factors that could lead to elevated PAP
Right heart catheterization


Evaluation for all factors that could lead to elevated PAP
Right heart catheterization


Evaluation for all factors that could lead to elevated PAP
Right heart catheterization


Evaluation for all factors that could lead to elevated PAP
Right heart catheterization

Other causes of PH not identified

Other causes of PH not identified

Other causes of PH not identified

Other causes of PH identified

Other causes of PH identified

Other causes of PH identified


Supplemental O2
Pulmonary rehabilitation
Referral for lung transplant if appropriate
Referral to a PH expert center (if not already)


Supplemental O2
Pulmonary rehabilitation
Referral for lung transplant if appropriate
Referral to a PH expert center (if not already)


Supplemental O2
Pulmonary rehabilitation
Referral for lung transplant if appropriate
Referral to a PH expert center (if not already)


Supplemental O2 2
Pulmonary rehabilitation
Referral for lung transplant if appropriate
Referral to a PH expert center (if not already)