How is pulmonary hypertension (PH) diagnosed?

Because pulmonary hypertension may be caused by many medical conditions, a complete medical history, physical exam, and description of your symptoms are necessary to rule out other diseases and make the correct diagnosis. During the physical exam, your healthcare provider will:

  • Listen for abnormal heart sounds, such as a loud pulmonic valve sound, a systolic murmur of tricuspid regurgitation, or a gallop due to ventricular failure.
  • Examine the jugular vein in the neck for engorgement (enlargement).
  • Examine the abdomen, legs, and ankles for fluid retention.
  • Examine nail beds for bluish tint.
  • Look for signs of other underlying diseases that might be causing pulmonary hypertension.

Other tests that might be ordered include:

  • Blood tests:
    • Complete metabolic panel (CMP): Examines liver and kidney function.
    • Autoantibody blood tests, such as ANA, ESR, and others: Screens for collagen vascular diseases.
    • Thyroid-stimulating hormone (TSH): A screen for thyroid problems.
    • HIV: A screen for human immunodeficiency virus.
    • Arterial blood gases (ABG): Determines the level of oxygen in arterial blood.
    • Complete blood count (CBC): Tests for infection, elevated hemoglobin, and anemia.
    • B-type natriuretic peptide (BNP): A marker for heart failure.
  • Doppler echocardiogram: Uses sound waves to show the function of the right ventricle, measure blood flow through the heart valves, and then calculate the systolic pulmonary artery pressure.
  • Chest X-ray: Shows an enlarged right ventricle and enlarged pulmonary arteries.
  • 6-minute walk test: Determines exercise tolerance level and blood oxygen saturation level during exercise.
  • Pulmonary function tests: Evaluates for other lung conditions, such as chronic obstructive pulmonary disease and idiopathic pulmonary fibrosis, among others.
  • Polysomnogram or overnight oximetry: Screens for sleep apnea (results in low oxygen levels at night).
  • Right heart catheterization: Measures various heart pressures (i.e., inside the pulmonary arteries, coming from the right side of the heart), the rate at which the heart is able to pump blood, and finds any leaks between the right and left sides of the heart.
  • Ventilation perfusion scan (V/Q scan): Looks for evidence of blood clots along the pathway to the lungs.
  • Pulmonary angiogram: Looks for blood clot blockages in the pulmonary arteries.
  • Chest CT scan: Looks for blood clots and other lung conditions that may be contributing to or making pulmonary hypertension worse.

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