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WHO Classification of Functional Status of Patients with PH* Class 1 Class 2 Class 3 Class 4 Patients with PH but without resulting limitation of physical activity. Ordinary physical activity does not cause undue dyspnea or fatigue, chest pain, or near syncope. Patients with PH resulting in slight limitation of physical activity. These patients are comfortable at rest, but ordinary physical activity causes undue dyspnea or fatigue, chest pain, or near syncope. Patients with PH resulting in marked limitation of physical activity.
There are no early symptoms of PAH, and thus, annual screening in high-risk populations should be considered. Risk groups thought to benefit from screening include patients with known genetic mutations, first-degree relatives of patients with PAH, patients with scleroderma, patients with portal hypertension before liver transplantation, and patients with congenital systemic to pulmonary shunts. The best screening test for the detection of PAH is a transthoracic echocardiogram (TTE). TTE is also a valuable tool to detect features of left-sided heart disease or intracardiac shunts.
29 is a key contributor. Platelets likely play an important role as procoagulants by increasing the platelet release of serotonin, vascular endothelial growth factor, and platelet-derived growth factor. Clinical Features PH frequently presents with nonspecific symptoms (Table 5). The most common symptoms are dyspnea on exertion, fatigue, and syncope, resulting from reduced cardiac output during activity. Patients may also occasionally present with anginalike chest pain with normal coronary arteries.