Diagnosis of Pulmonary Hypertension

Reviewed by: HU Medical Review Board | Last reviewed: February 2024

Pulmonary hypertension (PH) is a serious condition affecting the heart and lungs. PH occurs when there is increased pressure in the blood vessels of the lungs (pulmonary arteries). If left untreated, this pressure can cause serious problems. Timely diagnosis is key to managing PH effectively.1

How is pulmonary hypertension diagnosed?

Getting a PH diagnosis can involve a mix of noninvasive tests and more invasive procedures, but it starts with evaluating your symptoms.2

Your healthcare provider will ask you about your symptoms and how long you have had them. They will then do a physical exam to look at the state of your heart and lungs.2

A physical exam likely will involve a combination of the following:2,3

  • Listening to your heart and lungs
  • Measuring your blood pressure
  • Checking oxygen levels in your blood with a pulse oximeter
  • Looking for any bulging veins in the neck
  • Feeling your liver to see if it is larger than normal
  • Looking for any swelling in the feet, legs, or stomach

Your doctor also will ask about your medical history and any current medical conditions. Based on these assessments, your doctor may order other diagnostic tests. This will give them a clearer picture of what is causing your symptoms. They may also refer you to more specialized doctors.2-4

Types of diagnostic tests

Diagnostic tests help doctors get a more detailed view of the heart and lungs. The 2 main types of diagnostic tests used for PH are:1-4

  • Echocardiogram
  • Heart catheterization

Echocardiogram

An echocardiogram is one of the primary tests used for diagnosing PH. It is a noninvasive ultrasound test that uses sound waves to create detailed images of how blood is flowing through the heart. Doctors can use the results to identify whether there is elevated pressure in the pulmonary arteries. This increased pressure is a hallmark symptom of PH.1-4

Heart catheterization

Your doctor may do a heart catheterization to get a more precise measurement of pulmonary artery pressure. This is a more invasive approach.1-4

The procedure involves threading a thin, flexible tube (catheter) through the blood vessels to the heart. Then, the pressure in the pulmonary arteries and inside your heart is measured. This procedure allows doctors to confirm a PH diagnosis and see how severe it is.1-4

Other tests that may be used to diagnose PH include:1-4

  • Chest X-ray – Looks at the heart, lungs, and pulmonary arteries
  • Blood tests – Checks for signs of blood clots
  • Advanced imaging techniques – Provide more detailed visuals of the inside of the body. Examples include computed tomography (CT) and magnetic resonance imaging (MRI). These scans can help doctors see underlying causes of PH, such as blood clots or lung diseases.
  • Electrocardiogram (ECG or EKG) – Checks the electrical activity of the heart
  • Exercise stress tests – Look at how the heart responds to exercise
  • Genetic tests – If you have a family history of PH, your doctor may recommend genetic testing to understand your risk level.

Who diagnoses pulmonary hypertension?

Diagnosing PH often involves teamwork between several healthcare professionals. While a primary care provider may suspect the condition, specialists such as cardiologists and pulmonologists play a key role in making the official diagnosis.4,5

Primary care provider

Your journey to a PH diagnosis likely begins with a visit to your primary care provider. They will assess your symptoms and medical history. They also will do basic tests such as checking your blood pressure and listening to your lungs to see if you need to visit a specialist.4,5

Cardiologist

Cardiologists are doctors who specialize in treating heart-related conditions. They may order diagnostic tests to get a better understanding of what is going on in your heart and lungs. They may also work with other specialists to develop a treatment plan that meets your needs.4,5

Pulmonologist

Because PH affects the lungs, pulmonologists often are involved in the diagnostic process. These are doctors who specialize in the lungs and respiratory conditions. Their expertise helps identify how PH is affecting the lungs. They also can address any underlying lung issues.4,5

Why early diagnosis matters

The earlier PH is diagnosed and treated, the better the outcomes of the disease. Early diagnosis makes the disease easier to manage, and doctors can put together appropriate treatment plans as soon as possible. Timely treatment can help slow down the progression of the disease and improve long-term outcomes.1

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