Pulmonary Hypertension

Diagnosis

Hemodynamic right heart catheterization is necessary to confirm the severity and type of pulmonary hypertension and to determine the best approach to treatment. The test accurately measures pulmonary artery pressure and resistance, as well as blood flow throught the lungs. Under a local anesthetic, a thin tube is inserted into a vein, floated with the blood flow through the right side of the heart and into the pulmonary artery. The blood pressure in the pulmonary artery can then be directly measured.

Pulmonary angiography takes X-ray pictures of the pulmonary blood vessels (those in the lungs). A contrast material is injected into one or more arteries or veins so that they can be seen. It is injected via a catheter inserted through a vein (usually in the groin), through the chambers of the heart, and into the pulmonary artery, which leads to the lungs. This procedure is monitored by a fluoroscope (a type of X- ray that projects the images on a TV monitor).

Several additional noninvasive tests can help identify whether or not pulmonary hypertension is contributing to the patient's problem:

• Echocardiography enables the heart to be viewed as it pumps.
• Pulmonary function tests measure how much air the lungs can hold and how air moves into and out of the lungs.
• Perfusion lung scan measures the flow of a radioactive tracer in blood as it flows in the lungs.
• CT angiogram is a specialized x-ray scan of the chest which shows detailed structure of the pulmonary arteries, including blockages which might be present.
• Magnetic resonance imaging (MRI) uses strong magnetic fields instead of X-rays to view the structure of the heart and lungs.