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Referral guidelines

The Scottish Pulmonary Vascular Unit was established in 1999 and is funded by the National Services Division, Scotland. The unit provides diagnosis and management for all patients with pulmonary arterial hypertension (PAH) and Chronic Thromboembolic Pulmonary Hypertension (CTEPH) in Scotland.

New treatments for PAH approved over the last two decades have led to major improvements in the symptoms and prognosis of this serious condition. These include endothelin receptor antagonists, phosphodiesterase-5 inhibitors, guanylate cyclase stimulators and prostacyclin agents, both analogues and agonists. Clinical trials of new agents are ongoing.

Specialist supervision of all patients with pulmonary arterial hypertension remains essential. Treatment is increasingly complex and expensive and requires careful ongoing scrutiny.

Who to refer

Definitely refer

All suspected cases of pulmonary arterial hypertension (PAH)

  • Idiopathic or familial. 
  • Connective tissue disease associated (especially scleroderma, SLE, MCTD).
  • Congenital heart disease, pre and post-correction. 
  • Portopulmonary hypertension.
  • Other associated conditions:– HIV, anorexigen use, sickle cell disease.

All suspected cases of chronic thromboembolic pulmonary hypertension.

Consider referring

  • In hypoxic lung disease (COPD, interstitial lung disease, sleep disordered breathing) where the pulmonary artery pressure is excessively high (TRPG > 60 mmHg or PASP > 65 mmHg).
  • Patients with left heart disease where the severity of pulmonary hypertension is thought disproportionate to the left heart problem again typically TRPG > 60 mmHg or PASP > 65 mmHg).

It should be noted that treatment of pulmonary hypertension in these patient groups is not yet established.

Assessment prior to referring

  • All patients should have been seen by consultants in Cardiology or Respiratory prior to referral.
  • All patients should have an ECG, chest X-ray, lung function, transthoracic echocardiogram, VQ scan (and CTPA if the VQ scan is positive). We prefer to do cardiac catheterisation in Glasgow. Please do not delay referrals for extensive investigation if it is clear that PAH is the dominant problem.
  • Please include copies of reports (especially the echocardiogram) with the referral.

How to refer

  • Please send or fax the referral to the address below. An email with the referral as an attachment is also acceptable.
  • Patients can be admitted directly if clinic review is inappropriate or unnecessary.
  • For unwell patients with known or new PH, SPVU medical staff can be contacted for advice via radiopage or the hospital switchboard 24 hours/day and can arrange emergency transfer for assessment and treatment.

If there is doubt about whether to refer or assess further prior to referral, please contact SPVU medical staff to discuss.

Contacting the Scottish Pulmonary Vascular Unit

You can contact the Scottish Pulmonary Vascular Unit in several ways.
Call: 0141 951 5497
Fax: 0141 951 5948
Email: spvunit@gjnh.scot.nhs.uk
Write to:
Scottish Pulmonary Vascular Unit
Golden Jubilee University National Hospital
Agamemnon Street
West Dunbartonshire
G81 4DY

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