How Is Pulmonary Hypertension Diagnosed?
Your doctor will diagnose pulmonary hypertension
(PH) based on your medical and family histories, a physical exam, and the
results from tests and procedures.
PH can develop slowly. In fact, you may have it for
years and not know it. This is because the disease has no early symptoms.
When symptoms do develop, they're often like those
of other heart and lung conditions, such as
asthma.
This makes PH hard to diagnose.
Medical and Family Histories
To learn about your medical history, your doctor may
ask about your signs and symptoms and how and when they began. He or she also
may ask whether you have other medical conditions that can cause PH.
Your doctor also may ask whether you have any family
members who have or have had PH. People who have a family history of PH are at
increased risk for the condition.
Physical Exam
During the physical exam, your doctor will listen to
your heart and lungs with a stethoscope. He or she also will check your ankles
and legs for swelling and your lips and skin for a bluish tint. These are signs
of PH.
Diagnostic Tests and Procedures
You may need tests and procedures to confirm a
diagnosis of PH and to look for the underlying cause of the disease. Your
doctor also will use test results to find out the severity of your PH.
Tests and Procedures To Confirm a Diagnosis
Echocardiography. This test uses
sound waves to create a moving picture of your heart.
Echocardiography
(EK-o-kar-de-OG-ra-fee) can estimate the pressure in your pulmonary arteries.
The test also can show the size and thickness of your right ventricle and how
well it's working.
Chest x ray. A
chest
x ray takes pictures of your heart and lungs. This test can show whether
your pulmonary arteries and right ventricle are enlarged. The pulmonary
arteries and right ventricle may get larger if the right ventricle has to work
hard to pump blood through the pulmonary arteries.
Also, a chest x ray may show signs of an underlying
lung disease that may be causing or contributing to PH.
EKG (electrocardiogram). An
EKG
is a simple test that shows how fast your heart is beating. It also shows
whether your heart's rhythm is steady or irregular. An EKG may show whether
your right ventricle is enlarged or strained.
Right heart catheterization. This
procedure measures the pressure in your pulmonary arteries. It also shows how
well your heart is pumping blood to the rest of your body.
Right
heart catheterization (KATH-e-ter-i-ZA-shun) can find any leaks between the
left and right side of the heart.
During this procedure, a thin, flexible tube called
a catheter is put into a blood vessel in your groin (upper thigh) or neck. The
tube is then threaded into the right side of your heart and into the pulmonary
arteries. Through the tube, your doctor can do diagnostic tests and test
treatments on your heart.
Tests To Look for the Underlying Cause of Pulmonary
Hypertension
Lung function tests. Lung
function tests measure the size of your lungs, how much air you can breathe
in and out, how fast you can breathe air out, and how well your lungs deliver
oxygen to your blood. These tests can help find an underlying lung disease that
may be causing PH.
Overnight oximetry. This test
measures the level of oxygen in your blood overnight. A low oxygen level during
sleep is common in PH, and it can cause the condition to worsen.
For this test, a small light is attached to your
fingertip, earlobe, or toe. A machine that's attached to the light measures the
amount of oxygen in your blood throughout the night. In the morning, the light
is removed and your oxygen levels are recorded. Overnight oximetry can be done
at home or in a sleep lab.
Lung ventilation/perfusion (VQ)
scan. This test measures air and blood flow in your lungs. A
lung
VQ scan can show whether there are blood clots in your lung's blood
vessels.
Blood tests.
Blood
tests are used to rule out other diseases, such as HIV, liver disease, and
autoimmune diseases like rheumatoid arthritis.
Exercise testing. Exercise testing
consists of either a 6-minute walk test or a cardiopulmonary exercise test.
These tests can help find out whether another disease or condition is causing
your symptoms.
A 6-minute walk test measures the distance you can
quickly walk in 6 minutes. A cardiopulmonary exercise test measures how well
your lungs and heart work while you exercise on a treadmill or bicycle.
Finding Out the Severity of Pulmonary
Hypertension
Exercise testing is used to find out how severe PH
is. During this test, your doctor will rate your activity level. Your level is
linked to how severe your PH is. The rating system ranges from class 1 to class
4.
- Class 1 has no limits. You can do regular
physical activities, such as walking or climbing stairs. These activities don't
cause PH symptoms, such as tiredness, shortness of breath, or chest pain.
- Class 2 has slight or mild limits. You're
comfortable while resting, but regular physical activity causes PH
symptoms.
- Class 3 has marked or noticeable limits. You're
comfortable while resting. However, walking even one or two blocks or climbing
one flight of stairs can cause PH symptoms.
- Class 4 has severe limits. You're not able to do
any physical activity without discomfort. You also may have PH symptoms while
at rest.
Over time, you may need more exercise tests to find
out how well your treatments are working. Each time testing is done, your
doctor will compare your activity level to the previous one. |