How is pulmonary hypertension (PH) diagnosed?

Updated: Sep 11, 2019
  • Author: Swapnil Khoche, MBBS, DNB, FCARCSI; Chief Editor: Sheela Pai Cole, MD  more...
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Answer

Answer

The initial presentation of PH may be nonspecific, and thus diagnosis is often delayed. Exertional dyspnea, fatigue, and reduced exercise capacity are common initial complaints, which are usually slow both in onset and in progression. [8]

If the condition goes untreated, right-side failure results, manifested by clinical findings such as elevated jugular venous pressure, hepatomegaly, ascites, and lower-extremity edema, with cardiac examination revealing an RV lift, a loud P2, and a tricuspid regurgitation murmur. Electrocardiography (ECG) may display signs of PH, including a peaked P wave (P pulmonale), RV hypertrophy, RV strain, and an S1Q3T3 pattern. Signs of PH on chest radiography consist of RV enlargement, dilated pulmonary arteries, and peripheral pruning. [11]

Echocardiography is often used as a screening test for PH. Although this modality has the advantage of being noninvasive, it is relatively inaccurate for evaluating PAP. The primary value of echocardiography in PH lies in its ability to evaluate the function of the heart—specifically, the RV. It can help differentiate long-standing chronic disease that has been well compensated by RV hypertrophy from an acute exacerbation to which the RV is adapting poorly.

Classically, PH is evaluated by means of right-heart catheterization, which is the gold standard for obtaining accurate intracardiac pressures. Right-heart catheterization measures right atrial pressure (RAP), mPAP, PAWP, cardiac output by thermodilution, and mixed venous oxygen saturation (SmvO2). It also provides data for calculating PVR. This information is essential for disease severity assessment and accurate risk stratification. The roles of echocardiography and catheterization are expanded upon below (see Management).


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