- chest radiology - prominent central pulmonary vasculature with peripheral pruning (1)
- ECG may show right axis deviation and right sided strain (2)
- echocardiography - right atrial and right ventricular enlargement. This is a good screening test to detect pulmonary hypertension, but it always requires confirmation with right heart cardiac catheterisation as this is considered the definitive diagnostic test for pulmonary haemodynamic measurement (3,4)
Other investigative procedures are directed to exclude other causes of pulmonary hypertension, e.g.
- chronic pulmonary emboli
- cardiac valve disease
- chronic lung disease
Note
The 2022 European Society of Cardiology (ESC)/European Respiratory Society (ERS) guidelines advise a three-step approach to diagnosis of pulmonary hypertension: (4)
1. Suspicion by first-line physicians
2. Detection by echocardiography
3. Confirmation in a specialist centre
If it is suspected at any time in the patient evaluation, fast-track referral to a centre with expertise in its diagnosis and management is recommended.
Reference:
- American College of Radiology. ACR appropriateness criteria: suspected pulmonary hypertension. 2022 [internet publication].
- Ahearn GS et al. Electrocardiography to define clinical status in primary pulmonary hypertension and pulmonary arterial hypertension secondary to collagen vascular disease. Chest. 2002 Aug;122(2):524-7.
- Frost A, Badesch D, Gibbs JSR, et al. Diagnosis of pulmonary hypertension. Eur Respir J. 2019 Jan;53(1):1801904.
- Humbert M et al. ESC/ERS Scientific Document Group. 2022 ESC/ERS guidelines for the diagnosis and treatment of pulmonary hypertension. Eur Heart J. 2023 Feb 23:ehad005.