Pulmonary Hypertension

Diagnosis

Physicians at Mayo Clinic are experienced in accurately diagnosing pulmonary hypertension, which can be difficult to diagnose. A comprehensive diagnosis helps physicians determine the most appropriate treatment. Diagnostic testing uses the latest technology to determine the severity, cause and form of pulmonary hypertension.

Two invasive tests, right-heart catheterization and pulmonary angiography, help physicians arrive at a diagnosis:

Hemodynamic right-heart catheterization accurately measures pulmonary artery pressure and resistance, as well as blood flow through the lungs. After giving the patient a local anesthetic, the physician inserts a thin tube into a vein, threading it through the veins to the right side of the heart and into the pulmonary artery. The blood pressure in the pulmonary artery can then be measured. Depending on the findings, vasodilators administered during the test may also help physicians understand the condition and its possible treatment.

Pulmonary angiography takes X-ray pictures of the pulmonary blood vessels (vessels in the lungs). A contrast material, or dye, is injected into one or more arteries so physicians can view them on a monitor. The material is injected via a catheter inserted through a vein (usually in the groin), then threaded 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 monitor). Mayo physicians often conduct this test to help accurately diagnose pulmonary hypertension. The test is available at only a few medical centers in the United States.

In addition, several additional noninvasive tests can help identify whether pulmonary hypertension is a factor:

Magnetic resonance imaging (MRI) uses strong magnetic fields to view the structure of the heart and lungs. The MRI helps physicians measure the function of the right side of the heart. Physicians at Mayo Clinic are among a few in the nation to conduct this diagnostic test for pulmonary hypertension.

Echocardiography is one of the most common tests to diagnose pulmonary hypertension. Sound waves are used to produce detailed images of the patient's heart. Through a hand-held device (transducer) on the patient's chest, sound waves bounce off the heart and are reflected to produce video images of the heart's size, structure and motion. The echocardiogram enables physicians to view the heart as it pumps. Mayo Clinic is an internationally recognized leader in echocardiographic imaging.

Transesophageal echocardiogram may be conducted in some cases. A flexible tube that contains a transducer is guided down the esophagus. The transducer conveys detailed images of the heart.

Pulmonary function tests measure how much air the lungs can hold, how air moves into and out of the lungs, and how well the lungs exchange oxygen.

Perfusion lung scan measures the flow of a radioactive tracer in blood as it flows in the lungs. The tracer, which contains a very small amount of radioactive material, is injected into the bloodstream so circulation can be viewed. The perfusion lung scan helps determine if blood clots are causing symptoms of pulmonary hypertension.

CT angiogram is a specialized X-ray of the chest that shows detailed structure of the pulmonary arteries, including any blockages.

Blood tests may be conducted to measure biomarkers such as brain natriuretic peptide that help determine the severity of the condition.