[Structured evaluation of unclear dyspnea - of great importance to early identify patients with PAH and CTEPH and improve prognosis].

Dyspnea is a common distressing symptom which may be a sign of a critically threatening condition and has been linked with increased hospitalizations, reduced exercise tolerance and increased mortality. The current neuropsychological model suggests that dyspnea arises due to an imbalance between respiratory drive and achieved ventilation. Pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) are rare but detrimental conditions, with high morbidity and mortality, where early diagnosis and treatment initiation significantly improve outcome. These conditions are often accompanied by a diagnostic delay, which for PAH has not improved since the 1980s, underlining the importance of early evaluation and referral to specialists. In the present work, differential diagnoses of dyspnea are discussed along with a proposal on how a structured evaluation should be performed early to minimize the diagnostic delay in PAH and CTEPH and improve outcome.