Why PAH Is So Often Missed and What to Do About It

Sandra Chaparro, M.D., director of advanced heart failure at Miami Cardiac & Vascular Institute, part of Baptist Health South Florida, is on a mission to close the diagnosis gap in pulmonary arterial hypertension (PAH), a condition that remains widely misunderstood and dangerously underdiagnosed.

PAH is a disease in which the blood vessels in the lungs become thicker and narrower, making it harder for blood to pass through them. Unlike the blood pressure measured in a routine arm cuff reading, PAH is an entirely separate condition that directly affects the right side of the heart. Over time, as the heart works harder to push blood through increasingly restricted vessels, the right side weakens. Left undetected, this progression can lead to right-sided heart failure and serious, life-altering complications.

One of the greatest obstacles to early diagnosis, Chaparro explains, is that the symptoms of PAH can be subtle and easy to dismiss. Patients often experience shortness of breath, fatigue and diminished endurance, symptoms they may attribute to aging, being out of shape or everyday stress. That misattribution delays diagnosis, and in a disease where early intervention is critical, that delay matters. Her advice to patients is straightforward: Bring any abnormality to your physician's attention, because the heart and lungs work together, and catching increased lung pressure early is the key to protecting the heart before damage sets in.

When it comes to treatment, Chaparro frames PAH management as a true partnership. She often tells patients that managing this condition is a marathon, not a sprint, and that finishing well requires training, teamwork and a step-by-step approach. Goals include improving symptoms, slowing disease progression and protecting the heart, with treatment plans tailored to the individual patient. Because PAH therapies can be complex and sometimes expensive, often involving multiple medications simultaneously, she emphasizes that care must involve a full multidisciplinary team, including physicians, pharmacists and nurses, all working in coordination.

For patients newly diagnosed with PAH, Chaparro's message is one of measured hope. Following the treatment plan, maintaining open communication with care providers and committing to ongoing follow-up visits and testing can lead to meaningful improvements in quality of life. Patients should not face this journey alone, and receiving care at a center with dedicated PAH expertise makes all the difference.