Pulmonary hypertension (PH) is a disease characterized by high blood pressure due to hardening and narrowing of the pulmonary arteries, the vessels responsible for transporting blood from the right heart ventricle to the lungs. Although relatively rare, this severe condition can result in right heart failure and death. Early diagnosis is key to defining proper treatment, preventing complications, and improving patients’ quality of life.
The symptoms that occur are usually similar to ones characteristic of other heart or lung diseases, such as shortness of breath and chest pain. To diagnose pulmonary hypertension, a physician will use a patient’s medical and family histories, a physical exam, and the results of various tests, as explained in a report from the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH).
Pulmonary Hypertension Tests To Confirm Diagnosis
When the symptoms experienced by a patient indicate the possibility of pulmonary hypertension, a specialist needs to analyze the results of tests and procedures prior to confirming a PH diagnosis. An echocardiography is among the first pulmonary hypertension tests to analyze the heart, and uses soundwaves to create a moving image of the heart, estimate the pressure in the pulmonary arteries, and analyze the size, thickness, and function of the right heart ventricle.
A chest X-ray provides the physician with a picture of the chest structures, including the heart, lungs and blood vessels, which help to determine if the pulmonary arteries and right ventricle are enlarged, a sign of pulmonary hypertension. An electrocardiogram (EKG) records the electrical activity of the heart, showing its rhythm and size. In addition, right heart catheterization measures the pulmonary arteries’ pressure, shows the heart’s capacity to pump blood, and can reveal the existence of leaks between the right and left sides of the heart.
Pulmonary Hypertension Tests To Detect Underlying Causes
Pulmonary hypertension can have a number of underlying causes, meaning it is important to diagnose the cause correctly and treat the disease accordingly. Tests used for this purpose can include a chest computed tomography (CT) scan, which offers pictures of chest structures (heart, lungs, blood vessels) that may reveal signs of the condition responsible for secondary pulmonary hypertension. Chest magnetic resonance imaging (MRI) is used to analyze the function of the right heart ventricle and blood flow in the lungs to help detect signs of PH or its underlying condition.
In addition, lung function tests measure the amount of air a person can breathe in and out, the speed of breathing, and the capacity of the lungs to properly deliver oxygen to the blood, which can help diagnose a lung disease responsible for PH. A polysomnogram (PSG) is used to analyze if a low level of oxygen occurs during sleep, by recording brain activity, eye movement, heart rate and blood pressure while the patient is asleep.
A lung ventilation or perfusion (VQ) scan measures air and blood flow in the lungs to determine if blood clots are in the lungs’ vessels. Blood tests are used to exclude the possibility of other conditions, like HIV, liver disease, and rheumatoid arthritis or another autoimmune disease.
Tests to Evaluate the Severity and Stage of Pulmonary Hypertension
When the diagnosis is confirmed, the physician aims to analyze the severity and stage of the disease. To do so, an exercise test, consisting of either a six-minute walk test or a cardiopulmonary test, is requested. The walk test is used to measure the distance a person can quickly walk during that defined period of time, and the cardiopulmonary exercise test measures the lungs’ and heart’s capacity to function as the patient exercises on a treadmill or bicycle.
During these tests, the physician will rate the disease’s stage according to the World Health Organization’s classification. Patients placed in class 1 can do regular physical activities without experiencing PH symptoms (shortness of breath, chest pains, fatigue); class 2 patients are comfortable at rest, but regular physical activity causes PH symptoms; class 3 patients suffer marked or noticeable exercise limitations, despite being comfortable at rest; and class 4 patients have severe limitations, being unable to do any physical activity without discomfort, and likely suffer PH symptoms even at rest.
Diagnostic Methods Additional to Pulmonary Hypertension Tests
In addition to the tests and procedures used to confirm the diagnosis and possible underlying causes for the disease, or to evaluate a patient’s pulmonary hypertension stage, there is other data that physicians seek to collect. Patients are usually asked about their symptoms and other medical conditions, as well as medical and family histories. It is important to know if the patient has any family member with PH, since PH that is inherited is a known cause of the disease.
Physical examinations are also performed, with the physician not only listening to the heart and lungs with a stethoscope, but also checking the ankles and legs for swelling, and the lips and skin for a bluish color.
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