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Learning objectives After completing this module, participants should be better able to understand: • When to refer patients to a PAH centre • The pathophysiology of PAH • The functional classification of pulmonary hypertension • Screening for pulmonary hypertension Faculty Editor Dr Simon Gibbs, Clinical Senior Lecturer in Cardiology, National Heart and Lung Institute, Imperial College London, and Lead Clinician, National Pulmonary Hypertension Service, Hammersmith Hospital, London Contributors Dr Shareen Jaijee, Honorary Consultant Cardiologist, Imperial College Healthcare Trust, Clinical Research Fellow, Imperial College Dr Rachel

Introduction Postural tachycardia syndrome (PoTS) is a form of dysautonomia, a term used to describe dysfunction of the autonomic nervous system. Those living with PoTS can experience a vast array of symptoms that can be life-altering and debilitating.1 As well as a significant increase in heart rate upon standing, as a result of orthostatic intolerance, syncope and presyncope can occur, along with headaches, fatigue, palpitations, nausea and dizziness, which are usually relieved by lying down.2 Other autonomic functions, such as digestion, bladder control, temperature regulation and stress responses, may also be affected. Onset can be sudden

Introduction The National Institute for Health and Care Excellence (NICE) clinical guideline 95 (CG95) was published in March 2010 and offers guidance to National Health Service (NHS) institutions on the further investigation of possible diagnoses of stable angina, based on pretest probability of coronary artery disease (CAD).1 Some recommendations were controversial, however, including the recommendation that patients with a very high risk of CAD (>90%) could be treated without further routine investigation with invasive coronary angiography. In addition, use of computed tomography (CT) calcium scoring or CT coronary angiography (CTCA) is

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