Pulmonary hypertension is diagnosed based on your signs and symptoms, as well as your medical history, family history, and test results. Your doctor will listen to your heart and lungs using a stethoscope and examine your legs and ankles for signs of swelling.
Your doctor may also perform tests to diagnose pulmonary hypertension:
- CT scan: involves taking a series of X-ray images from different angles and combining them to create images showing cross-sections of the scanned area. These scans can be visually inspected for signs of pulmonary hypertension. CT scans show a greater degree of detail than X-rays and they are performed while you wear your regular clothes and do not involve any injections.
- Echocardiography: creates a moving picture of your heart using sound waves. Echocardiography can be used to estimate the pressure in the pulmonary arteries. It can also show the thickness and the size of the right ventricle, which can indicate how well it is working.
- Electrocardiogram (EKG): records the electrical activity in the heart. This can show if the heart’s rhythm is irregular. An EKG can also help doctors to determine if the right ventricle is enlarged or stressed.
- Pulmonary function tests: are tests used to determine how well your lungs work. They measure how much air you can breathe in, how much air you can breathe out, and how fast you can breathe it out, how well your lungs are delivering oxygen to your blood, and how strong your breathing muscles are.
- Right heart catheterization: uses a thin tube, called a catheter, to measure the pressure in the pulmonary arteries. The catheter is inserted into a blood vessel in the groin or neck and then threaded into the right side of the heart and pulmonary arteries. In addition to measuring blood pressure, using the catheter, your doctor can find leaks between the left and right side of the heart.
Your doctor may use exercise testing to determine the severity of your pulmonary hypertension. There are two types of exercise testing. The first is the six-minute walk test, which involves measuring the distance you can quickly walk in six minutes. The other test is the cardiopulmonary exercise test, which measures how well your heart and lungs function while you walk on a treadmill or pedal a stationary bicycle. These tests can help your doctor classify your pulmonary hypertension into one of four categories:
- Class 1: no limits on physical activities. Physical activity does not cause symptoms of pulmonary hypertension.
- Class 2: slight limits on physical activities. Physical activity causes mild symptoms of pulmonary hypertension, but you are comfortable while resting.
- Class 3: noticeable limits on physical activities. Even relatively mild physical activity, such as walking one or two blocks, causes symptoms of pulmonary hypertension. You are comfortable while resting.
- Class 4: severe limits on physical activities. You are unable to perform any physical activity without pulmonary hypertension symptoms. You may experience symptoms also while resting.