Detecting pulmonary hypertension (PH) can be tricky, as its most common symptoms—shortness of breath, fatigue, and dizziness—commonly occur alongside many other medical conditions.

When a doctor suspects the presence of HP in a patient, he or she will perform a review of medical and family history, in addition to a physical examination and specific tests.

Initial Medical Evaluation

Before ordering more advanced studies, the specialist performs a physical examination, in which he or she looks for:

Swollen or visible veins in the neck.

Irregular heartbeats.

Swelling in the extremities or abdomen (edema).

Subsequently, a series of diagnostic tests are recommended to determine the type of HP, its possible cause, and the most appropriate treatment.

Diagnostic Tests

Diagnosis may require various studies, such as:

Assessment of lung function.

Stress tests (such as a six-minute walk or a cardiopulmonary study).

Blood test.

Echocardiography.

However, the only way to confirm PH with certainty is through right heart catheterization (RHC).

Right heart catheterization is the gold standard for accurately diagnosing PH.

Tests to Determine the Type of Pulmonary Hypertension

There are different forms of pulmonary arterial hypertension (PAH), and identifying the specific type is key to guiding treatment.

Blood Tests and Immunology

The doctor may order a blood test to assess the patient's overall health and detect markers associated with PH. These tests help identify:

Function of organs such as the liver, kidneys, and thyroid.

Connective tissue diseases.

Signs of anemia or cardiac stress.

Blood oxygen and carbon dioxide levels (arterial blood gas).

Abdominal Ultrasound

If liver disease is suspected, an abdominal ultrasound is recommended to examine organs such as the liver, kidneys, spleen, and pancreas.

In some cases, portopulmonary hypertension (PPH) develops as a result of advanced liver disease, presenting with symptoms similar to those of group 1 PAH.

Once a diagnosis of HP is confirmed, doctors perform additional tests to personalize treatment and assess disease progression.

Studies to Evaluate Heart Function

Right Heart Catheterization

The CCD is a fundamental test in which a catheter is inserted into a vein (in the neck or groin) to guide it to the heart and measure the pressure in the pulmonary arteries.

This procedure allows for detailed analysis of blood flow and cardiac function. Blood samples can also be obtained for further studies.

In some cases, wedge pressure is measured, which provides information about the function of the left side of the heart. This helps differentiate between the different types of PH.

Right heart catheterization is the only test that can accurately confirm PAH.