Diagnosing Pulmonary Hypertension (PH)

Pulmonary hypertension (PH) can be difficult to diagnose in a routine medical exam because the most common symptoms of PH, such as breathlessness, fatigue and dizziness, are also associated with many other conditions. If your doctor suspects that you have PH, he or she will want to review your medical and family history, perform a physical exam and perform one or more diagnostic tests.

Preliminary Tests

To determine if you have PH and what type, your medical team will schedule specialized tests. If your medical team suspects PH as a result of one or more of the following tests, they will go on to schedule a rightheart catheterization, which is required to confirm diagnosis.

Blood Tests

Blood tests check the oxygen levels in the blood, they observe liver and kidney function, and they identify whether the patient has collagen vascular disease, thyroid problems, signs of infection or HIV antibodies. One test, the brain natriuretic peptide, helps to assess the strain on the heart and may also be used to monitor response to treatment.

Chest X-Rays

Chest X-rays can reveal an enlarged right ventricle or pulmonary arteries. Chest X-rays can also show signs of emphysema or scarring (interstitial fibrosis) of the lungs.

Electrocardiogram (ECG)

An electrocardiogram checks the electrical impulses of the heart. Electrodes are attached to the patient’s skin, and a recording of these impulses is made. However, an ECG alone is not enough to indicate a PH diagnosis. If your doctor performs an ECG, he or she will also perform one or more additional procedures to identify PH.

Echocardiogram

In this procedure, electrodes are placed on the patient’s skin, and a sonogram of the heart is taken. This painless procedure is often used to make a preliminary diagnosis by estimating the pressures in the right heart and assessing how well the heart is functioning. Other heart conditions that produce symptoms similar to PH may be diagnosed with an echocardiogram. In addition, an echocardiogram may be used to monitor a patient’s condition.

Pulmonary Function Tests

These tests measure how much air your lungs can hold, how much air moves in and out of them and the lungs’ ability to exchange oxygen. These tests may be performed to potentially identify its cause.

Exercise Tolerance Test (Six-Minute Walk Test)

During this test, a patient will be asked to perform an exercise, most commonly a six-minute walk. The purpose is to identity the patient’s exercise tolerance level.

Nuclear Scan (Ventilation/Perfusion Scan or V/Q Scan)

This diagnostic tool tests for blood clots in the lungs by producing a picture of air and blood flow to the lungs. A small dose of radioactive material is breathed in and another small dose is injected via a blood vessel into the lungs. The doctor will review the images that are produced to evaluate the health of the lungs.