TY - JOUR T1 - Pulmonary hypertension: a guide for GPs JF - British Journal of General Practice JO - Br J Gen Pract SP - e795 LP - e797 DO - 10.3399/bjgp12X658467 VL - 62 IS - 604 AU - Michelle J Connolly AU - Gabor Kovacs Y1 - 2012/11/01 UR - http://bjgp.org/content/62/604/e795.abstract N2 - Dyspnoea on exertion, impaired exercise tolerance, and fatigue are most often due to common cardiac and pulmonary diseases such as heart failure or COPD, but may be also due to pulmonary hypertension, a pathophysiological state of diverse aetiology that is frequently misdiagnosed or recognised late. Pulmonary hypertension has a poor prognosis; patients often take a long time to present and appropriate referral and treatment can be delayed.1Pulmonary hypertension is an umbrella term which describes a pathophysiological state characterised by the elevation of pulmonary artery pressure (PAP). It is diagnosed when the mean PAP is ≥25 mmHg at rest.2The most important challenge is to think of the condition, as its signs and symptoms are non-specific. The presenting complaint in about 60% of cases is shortness of breath on exertion, and is nearly always present at diagnosis. Another common presentation is fatigue. Dyspnoea at rest or syncope usually occur late. Clinical examination in the early stage may be unremarkable or may reveal a loud pulmonary component of the second heart sound and a pan-systolic murmur. A raised jugular venous pressure and pedal oedema indicate right heart failure in the advanced stage.Five groups of pulmonary hypertension are recognised,3 each reflecting the underlying aetiology. Group 1 comprises a rare pulmonary vascular disease called pulmonary arterial hypertension (PAH), which is characterised by progressive vascular remodelling. PAH can be idiopathic, heritable, induced by drugs or toxins, or associated … ER -