Lung
Pulmonary Hypertension Diagnosis
search
Pulmonary Hypertension Diagnosis
See Also
Pulmonary Arterial Hypertension
Pulmonary Hypertension
Pulmonary Hypertension Causes
Pulmonary Hypertension Management
Diagnosis
Step 1
Tests
Electrocardiogram
(EKG)
See
Right Ventricular Strain EKG Pattern
Right Axis Deviation
Right Ventricular Hypertrophy
Right atrial enlargement
Right strain pattern (S1Q3T3)
Sinus Tachycardia
Atrial Fibrillation
Anterior
T Wave Inversion
(leads V1-4)
Chest XRay
(abnormal in 90% of
Pulmonary Arterial Hypertension
)
Primary pulmonary artery dilation
Increased distal pulmonary vasculature markings
Right atrial and ventricular enlargement
Right Interlobar pulmonary diameter >16 mm
Hilar to thoracic ratio >0.44
Interpretation:
Pulmonary Hypertension
suggested
Proceed to Step 2 below
Diagnosis
Step 2
Tests:
Transthoracic Echocardiogram
(most useful)
Early findings
Tricuspid regurgitation
Peak pulmonary pressure estimated (Bernoulli equation)
Mean
Right Atrial Pressure
added to Peak tricuspid jet velocity
Systolic pulmonary artery pressure >35 to 40 mmHg consistent with
Pulmonary Hypertension
Late findings
Right ventricular dilation
Right Ventricular Hypertrophy
Displaced interventricular septum
Dilated main pulmonary artery
Interpretation
Precautions
Peak pulmonary pressure has poor accuracy and is operator dependent
Interpretation is best based on a general gestalt that there is high right sided heart pressure
Findings not consistent with
Pulmonary Hypertension
No further evaluation needed
Classification based on
Echocardiogram
findings
Left ventricular disease
Right Ventricular Failure
with elevated pulmonary artery pressure
Right Ventricular Failure
without elevated pulmonary artery pressure
Pericardial disease (
Cardiac Tamponade
)
Findings consistent with
Pulmonary Hypertension
No structural heart disease suspected
Follow Step 3 below
Structural heart disease suspected
Cardiac Catheterization (Gold standard)
Diagnosis
Step 3
Basic Tests (indicated in all cases)
Complete Blood Count
(CBC)
Evaluate for
Anemia
(high output
Heart Failure
)
Comprehensive Metabolic Panel (
Electrolyte
s,
Renal Function
tests,
Liver Function Test
s)
B-Type Natriuretic Peptide
(BNP)
Serum
Troponin
HIV Test
Thyroid Stimulating Hormone
(TSH)
Evaluate for
Hyperthyroidism
(high output
Heart Failure
)
Arterial Blood Gas
(ABG) or
Venous Blood Gas
Supplemental Oxygen
for all hypoxic patients
Oximetry (
6 Minute Walk Test
)
Pulmonary Function Test
s
Coagulation studies (PTT, INR)
Preparation for
Anticoagulation
Additional Tests as indicated
Sleep Study
Sickle Cell Anemia
screening
Imaging
CT
Chest
Liver
Ultrasound
Autoimmune panel
Anticentromere Antibody
level
Antinuclear Antibody
level
Anti-Scl-70 Antibody
level
Ribonucleoprotein Antibody
level
Interpretation of
Pulmonary Function Test
s (PFT)
Severe
Chronic Obstructive Lung Disease
(
COPD
)
See
COPD Management
Nearly normal PFT
Go to Step 4 below
Severe
Restrictive Lung Disease
Go to Step 5 below
Diagnosis
Step 4 (Normal PFT Evaluation)
Ventilation Perfusion Scan
(V-Q Scan)
Exclude chronic or recurrent
Pulmonary Embolism
Preferred over CT due to higher sensitivity for smaller multiple distal emboli
Interpretation of V-Q Scan
No segmental defects
Follow Step 5 below
One or more segmental defects
Obtain Pulmonary Angiogram
Pulmonary Angiogram shows no proximal embolism
Follow Step 5 below
Pulmonary angiogram shows proximal embolism
Treat
Pulmonary Embolism
Diagnosis
Step 5 (
Restrictive Lung Disease
Evaluation)
Test: High resolution CT
Chest
Exclude
Interstitial Lung Disease
Exclude mediastinal fibrosis
Interpretation
Normal or mediastinal fibrosis
Cardiac catheterization
Interstitial Lung Disease
Lung
biopsy for tissue diagnosis
References
McLaughlin (2009) Circulation 119(16): 2250-94 [PubMed]
Nauser (2001) Am Fam Physician 63(9):1789-98 [PubMed]
Rubin (1997) N Engl J Med 336:111-7 [PubMed]
Rubin (1993) Chest 104:236-50 [PubMed]
Type your search phrase here