To diagnose pulmonary hypertension, your doctor may ask you questions about your medical history and do a physical exam. Your doctor may also test you for pulmonary hypertension based on your signs and symptoms and risk factors. A diagnosis of pulmonary hypertension will be made if tests show higher-than-normal pressure in the pulmonary arteries.
Confirming high pressures in the pulmonary arteries
Normal pressure in the pulmonary arteries is between 11 and 20 millimeters of mercury (mm Hg) when measured by cardiac catheterization. Your doctor may perform the following tests to confirm high pressures in the pulmonary arteries.
- Cardiac catheterization to provide a definite diagnosis of pulmonary hypertension. A diagnosis of pulmonary hypertension is made if the pulmonary artery pressure is 25 mm Hg or greater while at rest.
- Echocardiography to estimate pulmonary artery pressure. An estimated pulmonary artery pressure of 35 to 40 mm Hg or greater on echocardiography suggests pulmonary hypertension. A diagnosis of pulmonary hypertension may be made when enough changes are seen on an echocardiogram. If the echocardiogram suggests pulmonary hypertension, then right heart catheterization may be the next step.
Medical history and physical exam
Your doctor may ask you about any signs and 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.
Your doctor may order blood tests and imaging tests to help diagnose pulmonary hypertension.
- Blood tests to look for increased risk of blood clots, stress on the heart, or anemia.
- Cardiac MRI to get detailed pictures of the structure and functioning of the heart and surrounding blood vessels.
- Chest X-ray to look at the size and shape of the heart and surrounding blood vessels, including the pulmonary arteries.
- Echocardiogram (echo) to look for signs of pulmonary hypertension and also study the heart’s structure and functioning. If the echocardiogram suggests pulmonary hypertension, then right heart catheterization may be the next step.
- Electrocardiogram (ECG or EKG) to look for signs of changes in your heart or abnormal rhythms in your heart’s electrical activity caused by pulmonary hypertension. You may still have pulmonary hypertension if you have a normal ECG.
Tests for other medical conditions
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.