How to Diagnose Pulmonary Arterial Hypertension

Diagnosing any medical condition typically begins with evaluating three key areas: clinical symptoms, physical examination findings, and diagnostic tests. In the case of pulmonary arterial hypertension (PAH), the most common and earliest symptom is shortness of breath, especially during physical activity. This symptom tends to progress over time and may even occur at rest in more severe cases. Other signs include fatigue, reduced exercise capacity, and general weakness, which are closely linked to decreased cardiac output and inadequate tissue perfusion.

Recognizing Key Symptoms

Fainting spells, or syncope, are also associated with PAH and are usually caused by a drop in blood flow to the brain due to reduced cardiac output. Chest pain or angina can occur due to right ventricular ischemia, thickening of the right ventricular muscle, or decreased coronary perfusion. Additional symptoms may include hemoptysis (coughing up blood), hoarseness, and signs of right-sided heart failure. During a physical exam, healthcare providers may detect abnormal lung sounds, swelling in the extremities, or other indicators of advanced disease.

Diagnostic Testing for Pulmonary Arterial Hypertension

One of the most definitive diagnostic tools for PAH is right heart catheterization, an invasive procedure that directly measures pulmonary artery pressure. A mean pulmonary artery pressure exceeding 25 mmHg at rest is considered a strong indicator of pulmonary hypertension. Beyond this, non-invasive tests such as echocardiography can reveal signs of right ventricular overload and hypertrophy, offering valuable insights into cardiac function.

Imaging and Additional Evaluations

Chest X-rays may show enlarged pulmonary arteries, while contrast-enhanced computed tomography (CT) scans can help identify structural abnormalities or underlying causes of elevated pulmonary pressure. These imaging modalities, when combined with clinical evaluation and symptom history, play a crucial role in confirming a diagnosis and guiding further treatment strategies.