Pulmonary hypertension may also be caused by other conditions, and in some
cases, the cause is unknown.
How is pulmonary hypertension 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 health care 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.
- 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, to 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 (ie, inside
the pulmonary arteries, coming from the left 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 worsening pulmonary hypertension.
How is pulmonary hypertension treated?
Appropriate diagnosis and analysis of the problem is necessary before
starting any treatment. Treatment varies per individual based on the different
underlying causes but generally includes taking medications; making lifestyle
and dietary changes; having surgery, if necessary; and seeing your doctor
regularly. Listed below are the medication and surgical treatment approaches.