Opinion
Video
Author(s):
Panelists discuss how early detection barriers include nonspecific symptoms like progressive dyspnea that are often misattributed to more common conditions, leading to delayed diagnosis and the need for improved diagnostic algorithms using biomarkers and imaging.
Clinical Presentation and Symptom Recognition
Early symptoms of pulmonary arterial hypertension are typically subtle and nonspecific, leading to frequent diagnostic delays and misdiagnoses. Progressive dyspnea on exertion represents the most common initial symptom, accompanied by fatigue and rapid exhaustion during physical activity. More severe symptoms like syncope and peripheral edema typically occur later in disease progression, often indicating advanced right heart dysfunction and poor prognosis.
The nonspecific nature of early PAH symptoms contributes to diagnostic challenges, with patients often experiencing months or years of evaluation by multiple physicians before receiving an accurate diagnosis. Recent European guidelines have introduced screening algorithms for general practitioners, incorporating ECG and biomarker measurements (BNP or NT-proBNP) to identify patients who warrant echocardiographic evaluation. While these tools lack perfect sensitivity, they provide valuable screening capabilities for symptomatic patients.
Improved diagnostic approaches emphasize the importance of reassessing patients who fail to respond to initial treatments for more common conditions like asthma or COPD. When patients continue experiencing unexplained dyspnea despite standard therapy, further evaluation becomes essential. This systematic approach, combined with increased awareness among healthcare providers, aims to reduce diagnostic delays and facilitate earlier referral to specialized pulmonary hypertension centers.
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