Pulmonary Hypertension Diagnosis

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To diagnose pulmonary hypertension, your doctor may ask you questions about your medical history and do a physical exam. Based on your symptoms and risk factors, your doctor may refer you to a lung specialist (pulmonologist) or a heart and blood vessel specialist (cardiologist). Your doctor will diagnose you with pulmonary hypertension if tests show higher-than-normal pressure in the arteries of the lungs (pulmonary arteries).

Your doctor may ask you about any symptoms you have been experiencing and any risk factors such as other medical conditions you have.

Your doctor will also perform a physical exam to look for signs that may help diagnose your condition. As part of this exam, your doctor may do the following:

• Check whether the oxygen levels in your blood are low. This may be done by pulse oximetry, in which a probe is placed on your finger to check your oxygen levels.
• Feel your liver to see if it is larger than normal.
• Listen to your heart to see if there are changes in how it sounds, and also to find out if your heartbeat is faster than normal or irregular or if you have a new heart murmur.
• Listen to your lungs for sounds that could be caused by heart failure or interstitial lung disease.
• Look at the veins in your neck to see if they are larger than normal.
• Look for swelling in your abdomen and legs that may be caused by fluid buildup.
• Measure your blood pressure.

There are many tests that doctors can use to tell if you have pulmonary hypertension.

The most common tests to measure the pressure in your pulmonary arteries are cardiac catheterization and echocardiography. Normal pressure in the pulmonary arteries is between 11 and 20 millimeters of mercury (mm Hg). If the pressure is too high, you may have pulmonary hypertension. A pressure of 25 mm Hg or greater measured by cardiac catheterization or 35 to 40 mm Hg or greater on echocardiography suggests pulmonary hypertension.

Other tests may include:

• Blood tests look for blood clots, stress on the heart, or anemia.
• Heart imaging tests, such as cardiac MRI, take detailed pictures of the structure and functioning of the heart and surrounding blood vessels.
• Lung imaging tests, such as chest X-ray, looks at the size and shape of the heart and surrounding blood vessels, including the pulmonary arteries.
• Electrocardiogram (ECG or EKG) looks for changes in the electrical activity of your heart. This can help detect if certain parts of the heart are damaged or working too hard. In pulmonary hypertension, the heart can become overworked due to damage or changes in the pulmonary arteries.

Your doctor may order additional tests to see whether another condition or medicine may be causing your pulmonary hypertension. Doctors can use this information to develop your treatment plan.