Patients should be assessed by a multidisciplinary group, which may include endocrinologists, dieticians, psychologists, specialist nurses, and experienced surgeons and anaesthetists. Patients should be evaluated for indicators of systemic or pulmonary hypertension, ischaemic heart disease, and heart failure. In addition to a detailed history and examination, the ECG may show indications of right ventricular hypertrophy. Further cardiac evaluation may include stress echocardiography and cardiopulmonary exercise testing.
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