History

The symptoms of PH are non-specific.

Progressive dyspnoea and fatigue that cannot otherwise be explained are the most common symptoms of PH. Although PH remains an uncommon cause of dyspnoea, a thorough evaluation of any patient presenting to the ED with dyspnoea in the absence of an alternative cause of cardiorespiratory disease is warranted.

What six pieces of information would you gather for a patient with a problem-focused history presenting with dyspnoea in the absence of an alternative cause of cardiorespiratory disease?

Answer:

1. the type and level of activity associated with dyspnoea;
2. timing of symptom onset and progression;
3. associated symptoms, including chest pain, palpitations, lower extremity oedema, near syncope, syncope and fatigue;
4. thorough review of cardiac, respiratory, rheumatological, neurological and haematological systems;
5. family history of PH;
6. drug history particularly, use of aminorex, fenfluramine, SSRIs, amphetamines, cocaine, interferon alpha and beta, chemotherapeutic agents such as mitomycin C, cyclophosphamide