Diagnosing pulmonary hypertension (PH) involves a combination of medical history, physical examination, imaging studies, and specialized tests. Here’s an outline of the key steps:
- Medical History and Physical Exam
- Symptoms: Patients with PH often present with symptoms like shortness of breath, fatigue, chest pain, dizziness, and swelling in the legs or abdomen.
- Physical Signs: A physician may detect abnormal heart sounds, such as a loud P2 (a component of the second heart sound), signs of right-sided heart failure (e.g., jugular venous distension), or hepatomegaly.
- Imaging Tests
- Echocardiography (Echo): This is typically the first test. It estimates pulmonary artery pressures, assesses right heart function, and checks for structural abnormalities that might suggest PH.
- Chest X-Ray: It can show enlarged pulmonary arteries and right heart enlargement, though it’s not definitive for diagnosis.
- CT or MRI of the Chest: These may be used to get a clearer view of the heart and lung structures.
- Pulmonary Function Tests (PFTs)
- These tests assess lung function to determine if any underlying lung disease might be contributing to or causing the PH.
- These tests assess lung function to determine if any underlying lung disease might be contributing to or causing the PH.
- Blood Tests
- BNP or NT-proBNP: Elevated levels of these biomarkers can suggest heart strain, often seen in PH.
- Autoimmune and Liver Function Tests: These can help detect diseases associated with PH, like connective tissue disorders or liver disease.
- Right Heart Catheterization (RHC)
- Gold Standard: This invasive test directly measures the pulmonary artery pressure, confirming the diagnosis and helping assess severity. It’s essential to distinguish PH from other conditions and to guide treatment.
- Gold Standard: This invasive test directly measures the pulmonary artery pressure, confirming the diagnosis and helping assess severity. It’s essential to distinguish PH from other conditions and to guide treatment.
- Exercise Testing
- Six-Minute Walk Test or Cardiopulmonary Exercise Testing can be used to gauge exercise tolerance, which may help in assessing PH severity and tracking treatment response.
- Six-Minute Walk Test or Cardiopulmonary Exercise Testing can be used to gauge exercise tolerance, which may help in assessing PH severity and tracking treatment response.
- Sleep Study (Polysomnography)
- To rule out sleep apnea as a cause, since it is a treatable risk factor for PH.
- To rule out sleep apnea as a cause, since it is a treatable risk factor for PH.
- Diagnostic Criteria
- Pulmonary Artery Mean Pressure (mPAP): PH is diagnosed when mPAP is ≥20 mmHg at rest as measured by right heart catheterization.