How is Pulmonary Arterial Hypertension diagnosed?

Ideally, Pulmonary arterial hypertension (PAH) should be diagnosed as early as possible so that patients can begin treatment but unfortunately, this does not always happen.

The early symptoms of Pulmonary Arterial Hypertension (PAH) - breathlessness, dizziness and fatigue - are often mild and are common to many other conditions.  Diagnosis can be delayed for months or even years while other possible causes are investigated and as a result, Pulmonary Arterial Hypertension (PAH) is frequently only identified when it is already quite advanced.^1,2

It is difficult to diagnose Pulmonary Arterial Hypertension (PAH) purely on the basis of symptoms and there is no single test for the condition.  Diagnosis is usually based on a medical history and a series of investigations that are designed to measure heart and lung function and to rule out other conditions. These can include ³:

• an ultrasound of the heart called a Doppler echocardiogram

• a test to measure the electrical activity of the heart - an Electrocardiogram (ECG)

• a six-minute walk test which assesses how far someone can walk in six minutes, or other types of exercise testing

• lung function tests to see whether the airways are narrower than normal

• a CT scan (a computerised scan that takes a picture of the body) to investigate for types of lung disease

• a sleep study to rule out Sleep Apnoea (a condition where breathing stops briefly during sleep)

If PAH is suspected, a diagnosis can be confirmed using a procedure called Right heart catheterisation. This involves inserting a small tube into the heart to give a direct measure of pressure in the heart and lungs.^1,2 This test usually involves a short stay in hospital.

References
1. Gibbs J, Higgenbottam T. Recommendations on the management of pulmonary hypertension in clinical practice. Heart (2001);86(1):i1-i13
2. Humbert M, Sitbon O, Chaouat A et al. Pulmonary Arterial Hypertension in France: Results from a National Registry. Am J Respir Crit Care Med 2006; 173(9): 1023-30
3. Barst RJ, McGoon M, Torbicki A, et al. Diagnosis and differential assessment of pulmonary arterial hypertension. J Am Coll Cardiol 2004;43 (Suppl S): 40-47S