Pulmonary Hypertension
Diagnosis

Pulmonary hypertension in its early stages is difficult to recognize on routine physical exam. It may be two or three years after onset that symptoms become severe enough to be noticed.

Pulmonary hypertension is diagnosed primarily with an echocardiogram, which is an ultrasound examination of the heart. The echocardiogram measures the heart's size and shape by using sound waves to create an image of the heart and can estimate the pulmonary artery pressure.

• Electrocardiogram (ECG or EKG) to measure your heart's electrical function
• Right heart catheterization to measure blood pressure inside the heart and blood vessels of the lungs and measure blood flow. This test is performed in all patients to confirm the diagnosis and to help guide therapy.
• Six-minute walk test
• Assessment of how well you accomplish daily living tasks

If your doctor determines that you have pulmonary hypertension, the next task is to find out what is causing it. The tests to determine the cause include:

• Computerized tomography, called CT or CAT, scan to see if there is a blood clot or other disease in your lungs
• Pulmonary function test to rule out obstructive lung disease
• Sleep study to see if you have sleep apnea, a condition in which you may stop breathing during sleep
• Lab tests to rule out hepatitis, collagen disease, HIV or other conditions

If no discernible cause for the pulmonary hypertension is found, then the diagnosis of primary pulmonary hypertension is made. If a cause is elucidated, then the diagnosis is secondary pulmonary hypertension.

The New York Heart Association and the World Health Organization (WHO) use the following system to classify pulmonary arterial hypertension.

Pulmonary hypertension is divided into four classifications:

• Class 1. You've been diagnosed as having the disease but show no symptoms. Ordinary physical activity doesn't cause undue discomfort.
• Class 2. Your symptoms occur only with activity but not when you're at rest
• Class 3. There are no symptoms at rest but they occur with even slight exertion
• Class 4. You have symptoms even at rest