Pulmonary Hypertension Unit
How to Refer
To refer a patient to the National Pulmonary Hypertension Unit, a referral letter can be sent:
- Via post, addressed to: Prof. Sean Gaine, Consultant Respiratory Physician, National Pulmonary Hypertension Unit, 56 Eccles street, Mater Misercoridiae Hospital, Dublin 7
- Fax referrals to the pulmonary hypertension unit at 01 8545176
- Email referrals to: profgainepph@mater.ie
- Please contact the pulmonary hypertension unit office if an urgent referral is required: +3531 8034420
Rescheduling Appointments and Cancellations
Your appointment is very important to us and in the case that you cannot attend, please let us know by contacting the pulmonary hypertension unit on 01 8034420, so that we can reschedule your appointment and offer this visit to another person.
Clinical nurse specialist contact details
Our clinical nurse specialists include:
Catriona Minnock: cminnock@mater.ie and pager 3247
Denise Lennon: deniselennon@mater.ie and pager 3247
Salima Meghani: salimameghani@mater.ie and pager 3349
Additional information for referring clinicians:
While we are happy to accept referrals without a complete diagnostic evaluation for pulmonary hypertension from both primary and secondary care, we have provided a list of suggested investigations and relevant results that may be of use to referring clinicians:
Investigations include:
- Baseline serology:
- FBC, Renal, Liver, Bone profile
- BNP or NT-proBNP
- Connective tissue disease screen, HIV, hepatitis screen
- TFTs, uric acid, iron studies
- 6MWT
- ECG & Electrocardiography (with right heart protocol)
- Chest X Ray & CT thorax/CT pulmonary angiogram
- Pulmonary Function tests
- Abdominal USS
- Echocardiogram with right heart protocol
- Ventilation Perfusion Scan (+/- IR guided Pulmonary Angiogram if CTEPH is suspected)
- Right Heart Catheterization
Right heart catheterisation:
The below parameters obtained during RHC are particularly useful in the pulmonary hypertension unit for diagnostic and prognostic purposes:
- Mean pulmonary artery pressure
- Pulmonary artery wedge pressure
- Pulmonary vascular resistance
- Right atrial pressure
- Cardiac Output
- Cardiac index
- Mixed venous saturations
- Pulmonary artery saturations
Consider:
A fluid challenge with 500ml of intravenous fluid should be considered during RHC, if there is persistent suspicion for group 2 PH, despite a normal PAWP (< 15mmHg). This should only be performed if relevant and safe.
Examples of key risk factors for Group 2 PH: (ref 1)
| Clinical presentation | Echocardiography | Other features |
| Age >65 years | Structural left heart abnormality • Disease of left heart valves • LA enlargement (>4.2 cm) • Bowing of the IAS to the right • LV dysfunction • Concentric LV hypertrophy and/or increased LV mass | ECG • LVH and/or LAH • AF/Afib • LBBB • Presence of Q waves |
| Symptoms of left heart failure | Doppler indices of increased filling pressures • Increased E/e’ • >Type 2-3 mitral flow abnormality | Other imaging • Kerley B lines • Pleural effusion • Pulmonary oedema • LA enlargement |
| Features of metabolic syndrome | Absence of • RV dysfunction • Mid systolic notching of the PA flow • Percardial effusion | |
| History of heart disease (past or current) | ||
| Persistent atrial fibrillation |
Galiè et al (2015)
Note:
Vasoreactivity testing is performed during RHC in specific circumstances (IPAH, HPAH, PAH associated with drugs), under direct supervision by the PH team, due to the potential risk of hemodynamic compromise during vasodilator administration.
References:
1. Galiè N, Humbert M, Vachiery J-L, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension. The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS)Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT) 2015; 46: 903-975. DOI: 10.1183/13993003.01032-2015.
