Diagnosing Pulmonary Hypertension: Methods and Medical Evaluations

Pulmonary hypertension can manifest as a primary condition, a secondary complication, or part of a broader syndrome. The definitive diagnostic criterion for pulmonary hypertension is a mean pulmonary artery pressure of 25 mmHg or higher, measured at rest and at sea level using right heart catheterization.

Common Symptoms of Pulmonary Hypertension

Patients with pulmonary hypertension often experience a range of symptoms, including shortness of breath, persistent fatigue, dizziness, chest pain, and in severe cases, hemoptysis (coughing up blood), hoarseness, and signs of right-sided heart failure. These clinical manifestations prompt further diagnostic investigation.

Diagnostic Tools and Laboratory Tests

To confirm a diagnosis, various diagnostic tools and lab tests are employed. Blood tests may include measuring brain natriuretic peptide (BNP) levels and performing arterial blood gas analysis. Electrocardiograms (ECG) can detect signs of right ventricular strain or hypertrophy and right atrial enlargement. Chest X-rays might show an enlarged right lower pulmonary artery with a diameter of 15 mm or more.

Echocardiography is a crucial non-invasive method for estimating pulmonary artery pressure and evaluating heart function. High-resolution CT scans and contrast-enhanced CT imaging help assess the size and pressure of the right lower pulmonary artery. Cardiopulmonary exercise testing can also be used to evaluate overall cardiac function and gas exchange efficiency.

Advanced Imaging and Invasive Procedures

In certain cases, pulmonary angiography is performed to rule out conditions such as pulmonary embolism or pulmonary artery tumors. This imaging technique provides detailed visualization of the pulmonary vasculature and helps guide further treatment decisions.

Identifying High-Risk Individuals

Early diagnosis begins with identifying individuals at higher risk, such as those with underlying heart conditions or a history of thromboembolic disease. Echocardiography is often used as a screening tool, while right heart catheterization remains the gold standard for confirming the presence and severity of pulmonary hypertension.