Like any other disease, a patient’s healthcare provider will diagnose PH by collecting information about medical history as well as family history. A physical exam will be administered along with a number of other tests and procedures. Symptoms of PH can develop over a long period of time and mimic other heart and lung conditions (i.e. bronchitis and asthma), making PH very difficult to diagnosis. Misdiagnosis is not uncommon. However, initially, a doctor will try to confirm a PH diagnosis and look for an underlying cause. Remember, there can be many causes of PH.
Tests to confirm PH
There are a number of different diagnostics for pulmonary hypertension diagnosis. Note that not all of the tests below will necessarily need to be conducted in order to determine PH in a patient. In addition to these tests, medical and family history along with symptoms will narrow down what tests are appropriate.
- Echocardiogram – Sound waves generate a moving picture of the heart. This can measure pulmonary artery pressure. The doctor can also observe the thickness and size of the heart’s right ventricle. This is a safe, noninvasive procedure.
- Chest X-ray – This can tell the doctor if the heart’s right ventricle and pulmonary arteries are enlarged, as well as general heart and lung anatomy. X-rays have been known to demonstrate signs of underlying lung disease making them very useful for PH diagnosis.
- Electrocardiogram (EKG) – This device measures electrical impulses from the heart with external electrodes placed on the body. This test can see whether a person’s heartbeat is regular or irregular, and may indicate if the heart’s right ventricle is enlarged. This is a safe and noninvasive procedure.
- Right heart catheterization – This test uses a flexible tube (catheter) which is inserted into a blood vessel in a patent’s groin or neck region. The tube is then threaded into the right side of the heart and into the pulmonary arteries. This test can measure pulmonary artery pressure and can demonstrate how efficiently the heart is pumping blood to the rest of the body. This system allows the physician to apply treatments to the heart as well.
Tests to find the underlying cause of PH
Tests to confirm PH are important; however, beyond that, patients need to know what caused the onset of pulmonary hypertension. This is important, as it will determine an appropriate treatment(s). Remember: there are many causes of all of the PH forms, so the underlying cause must be determined.
- Lung function tests – These tests measure how well a patient’s lungs work, and are used to determine the cause of breathing problems. These tests look at how much air a patient can take into their lungs, and how much they can blow out, etc. This helps the doctor determine whether a patient has asthma, COPD (chronic obstructive pulmonary disease), or something else.
- CT scan (computerized tomography) – This scan is done on the chest to get a picture of the structures within the chest, such as blood vessels, lungs, and heart. Lesions observed may indicate an underlying cause for PH.
- Magnetic resonance imaging (MRI) – An MRI can be done on the chest that can provide information about how the heart’s right ventricle is working. It can also demonstrate how blood flows through the lungs. MRI can help identify an underlying cause of PH.
- Polysomnogram or (PSG) – This is an interesting test in that it is given to patients while they sleep. This system records information about blood pressure, heart rate, brain activity, and eye movements. It can measure oxygen levels in blood which is important because PH patients commonly have low oxygen levels when they are asleep.
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