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Tests and diagnosis
By Mayo Clinic staffPulmonary hypertension is hard to diagnose early because it's not often detected in a routine physical exam. Even when the disease is more advanced, its signs and symptoms often mimic those of other heart and lung conditions. An echocardiogram is usually used to diagnose pulmonary hypertension. However, your doctor may do one or more tests to rule out other possible reasons for your condition. Tests to diagnose pulmonary hypertension include:
- Echocardiogram. Your doctor may first suspect you have pulmonary hypertension based on the results of this test. This noninvasive test uses harmless sound waves that allow your doctor to see your heart without making an incision. During the procedure, a small, plastic instrument called a transducer is placed on your chest. It collects reflected sound waves (echoes) from your heart and transmits them to a machine that uses the sound wave patterns to compose images of your beating heart on a monitor. These images show how well your heart is functioning, and recorded pictures allow your doctor to measure the size and thickness of your heart muscle. Sometimes your doctor will recommend an exercise echocardiogram to help determine how well your heart works under stress. In that case, you'll have an echocardiogram before exercising on a stationary bike or treadmill and another test immediately afterward.
- Transesophageal echocardiogram. If it's difficult to get a clear picture of your heart and lungs with a standard echocardiogram, your doctor may recommend a transesophageal echocardiogram. In this procedure, a flexible tube containing a transducer is guided down your throat and into your esophagus. From this vantage point, the transducer can obtain detailed images of your heart.
- Pulmonary function test. This noninvasive test measures how much air your lungs can hold, and the airflow in and out of your lungs. During the test, you'll blow into a simple instrument called a spirometer.
- Perfusion lung scan. This test uses small amounts of radioactive substances (radioisotopes) to study blood flow (perfusion) in your lungs. The radioisotopes are injected into a vein in your arm. Immediately afterward, a special camera (gamma camera) takes pictures of blood flow in your lungs' blood vessels. A lung scan is then used to determine whether blood clots are causing symptoms of pulmonary hypertension. It's usually performed with another test known as a ventilation scan. In this test, you inhale a small amount of radioactive substance while a gamma camera records the movement of air into your lungs. The two-test combination is known as a ventilation-perfusion (V/Q) scan, and in its entirety usually takes less than an hour with side effects or complications rarely occurring.
- Right heart catheterization. Performed on an outpatient basis using local anesthesia, this test is often the most reliable way of diagnosing pulmonary hypertension. During the procedure, a cardiologist places a thin, flexible tube (catheter) into a vein in your neck or groin. The catheter is then threaded into your right ventricle and pulmonary artery. Right heart catheterization allows your doctor to directly measure the pressure in the main pulmonary arteries and right ventricle. It's also used to evaluate the effect different drugs may have on your heart in order to find the most effective treatment.
- Computerized tomography (CT). A CT scan allows your doctor to see your organs in two-dimensional "slices." In this test, you'll lie in a machine that takes images of your lungs so that your doctors can see a cross-section of them. You might also be given a medication that makes the images of your lungs show up more clearly.
- Magnetic resonance imaging (MRI). This test uses no X-rays. Instead, a computer creates tissue "slices" from data generated by a powerful magnetic field and radio waves. It can't, however, measure artery pressure — a procedure that's necessary if you're taking medications to control IPH. But it can get good images of the pulmonary vessels.
- Genetic tests. If a family member has had pulmonary hypertension, your doctor may screen you for genetic mutations that are linked with pulmonary hypertension to confirm a diagnosis. If you test positive, your doctor may recommend that other family members be screened for the same genetic mutation.
- Open-lung biopsy. In rare situations your doctor may recommend an open-lung biopsy. An open-lung biopsy is a type of surgery in which a small sample of tissue is removed from your lungs to check for pulmonary hypertension.
While shortness of breath is one of the first symptoms of pulmonary hypertension, this symptom is also common with many other diseases, such as asthma. But, if you're constantly short of breath, rather than only occasionally as is usually the case with asthma, see your doctor.
Pulmonary hypertension classifications
Once you've received a diagnosis of pulmonary hypertension, your doctor may classify the disease using guidelines developed by the New York Heart Association.
- Class I. Although you've been diagnosed with pulmonary hypertension, you have no symptoms.
- Class II. You don't have symptoms at rest, but you experience fatigue, shortness of breath or chest pain with normal activity.
- Class III. You're comfortable at rest but have symptoms with slight exertion.
- Class IV. You have symptoms even at rest.
