How Doctors Diagnose Pulmonary Hypertension

Jason, 38, assumed he felt so tired due to all the overtime he'd been putting in on weekends. However, after several episodes of lightheadedness, he made an appointment with his doctor. The eventual diagnosis was pulmonary hypertension. Jason's mother revealed that her late father had suffered from the same condition.

Overview of Pulmonary Hypertension

Doctors often refer to this disorder as PH. It's one type of high blood pressure. According to the National Heart Lung and Blood Institute, the term refers to increased pressure in a patient's pulmonary arteries. These vessels transport blood from the heart to the lungs, where it finds oxygen. Once it's rich in oxygen, the blood gets pumped throughout the body.

The Mayo Clinic indicates that this type of elevated pressure occurs only in the arteries in the lungs and the right side of the heart. The disease process starts with small alterations in the cells of the lining of the arteries in the lungs. As a result, the artery walls tighten. Sometimes the walls are stiff at birth and in some patients, they stiffen due to cell overgrowths. Blood clots can form. When it eventually becomes tough for the individual's heart to pump blood, the pressure in the affected arteries rises.

Experts believe heredity plays a part in causing some types of PH. Certain diseases and the use of street drugs like cocaine are sometimes the culprits.

The most common signs and symptoms of pulmonary hypertension are shortness of breath during routine activities, chest pain, fatigue and a racing heartbeat. Patients might also experience lightheadedness, fainting, a bluish tinge to their skin and lips and swelling in the ankles and legs.

Reaching a Diagnosis

PH is a difficult condition to diagnose in its early stages. At that point, patients might experience few symptoms. Doctors frequently miss the disorder during a routine physical. As the illness progresses, symptoms become more pronounced. Unfortunately, even when advanced, the disorder mimics a number of other conditions.

The standard tests used to diagnose pulmonary hypertension include:

Chest X-ray. Films can reveal whether a patient's right ventricle or pulmonary arteries are enlarged. However, X-rays appear normal for around one out of every three patients.

Echocardiogram. Sound waves allow a physician to image the heart and measure its size and thickness. Some doctors order stress echocardiograms.

Transesophageal echocardiogram. This procedure provides clearer images than those from a standard echocardiogram. A tube placed down the throat and into the esophagus reveals images of the heart.

Heart catheterization. When an echocardiogram suggests the possibility of pulmonary hypertension, doctors perform this procedure to directly measure the pressure in the right ventricle of the heart and in the principal pulmonary arteries. They accomplish this by threading a catheter directly into these areas under local anesthesia.

Pulmonary function test. This procedure involves blowing into a pyrometer and measuring lung capacity.

Perfusion lung scan. Radioisotopes injected into a vein track blood flow in the lungs. A camera then takes pictures of the blood as its flows through vessels in the lungs. The scan can reveal blood clots.

Computerized tomography (CT) scan. The purpose of a CT scan is to show images in two dimensions, providing a doctor with a cross-section of the lungs to aid in a diagnosis.

Magnetic resonance imaging (MRI). Although it also generates images in the form of slices, an MRI can't measure arterial pressure.

Open-lung biopsy. During this procedure, a surgeon removes a sample of lung tissue. The only reason to have this type of surgery is to discover whether some treatments might be effective or whether to discontinue others.

Genetic testing. It's helpful for screening when there is a family history of pulmonary hypertension. When an individual has the defective gene mutation associated with this condition, all family members should be screened.

Prognosis

This disorder isn't curable. It's a serious progressive illness that's sometimes fatal. The objective of treatment is to help reduce a patient's symptoms and maintain the maximum quality of his or her life. Patients who are able to get an early diagnosis of pulmonary hypertension have the best chance of controlling its symptoms and reaching that goal.

Sources:

http://www.nhlbi.nih.gov/health/dci/Diseases/pah/pah_what.html

http://www.mayoclinic.com/health/pulmonary-hypertension/DS00430