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Pulmonary Hypertension Diagnosis

How is Pulmonary Arterial Hypertension Diagnosed? There is no one specific test that will show why you have PAH. Even in its later stages, the signs of the disease are similar to those of other heart and lung conditions.

Your doctor will determine if you have PAH by conducting a series of tests to:

  • Determine the pressure in your pulmonary artery
  • Find out how well your heart and lungs are working
  • Rule out any other conditions that may be causing the hypertension

These tests include:

  • Chest X-ray. A chest x-ray takes a picture of your heart and lungs. It can show if the pulmonary arteries or the right side of the heart are enlarged. It will also help your doctor rule out a number of lung diseases, including COPD, as the cause of your PAH.
  • EKG or ECG (electrocardiogram). This test is used to measure the rate and regularity of your heartbeat, as well as the size and position of the right ventricle in your heart. It can help the doctor rule out a number of diseases of the heart.
  • Doppler Echocardiogram. This test shows whether the right side of your heart is enlarged and how well it is functioning. It is the most reliable noninvasive test for obtaining an estimate of the blood pressure in the pulmonary artery.
  • Stress Test. This test helps the doctor evaluate the effect of exercise on your heart.
  • Spirometry (spi·rom·e·tre) measures how well your lungs inhale and exhale air. It is most useful for ruling out obstructive lung diseases like COPD.
  • Cardiac Catheterization. This test provides a precise measure of the blood pressure in the right side of your heart and the pulmonary artery. It is the only way to get this measure. It also shows the amount of blood the right ventricle pumps with each heartbeat. This helps your doctor evaluate the pumping ability of the right ventricle. This procedure must be performed in the hospital by a specialist.

Usually, these tests are sufficient to confirm that you have PAH. Sometimes these tests do not rule out all possible causes for the PAH. In that case, your doctor may call for these additional tests:

  • Perfusion Lung Scan. This test shows how the blood is moving in your lungs and whether there are large blood clots that may be causing the PAH.
  • Pulmonary arteriography. When the results of a perfusion lung scan do not rule out blood clots in the pulmonary arteries, your doctor may order a pulmonary arteriogram. This test also shows blood clots and other blockages in the blood vessels in the lung.
  • Blood tests to rule out HIV, auto-immune diseases like scleroderma, and liver disease.
  • Polysomnography (poly·som·nog·ra·phy): This test will help your doctor rule out sleep-disordered breathing as a cause of your pulmonary hypertension.

If these tests do not show an underlying cause for the PAH, the diagnosis is PPAH.

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