Diagnosis and tests for Pulmonary Hypertension

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The effectiveness of the treatment of pulmonary hypertension depends, to a large extent, on making a diagnosis as soon as possible.  

The objectives of the diagnostic tests are to determine the type of pulmonary hypertension, identify possible causes and assess severity. The most important diagnostic tests are:

Person who has a chest x-ray where the lungs can be seen

Chest X-ray. Dilation of the main pulmonary arteries and their branches is usually seen, with decreased peripheral vascularisation. Increased heart size due to enlargement of the right heart chambers is common.

Heart and electrocardiogram, heart palpitations

Electrocardiogram (ECG). The ECG result is normal in up to 90% of cases. This is a non-invasive examination to study the electrical activity of the heart at a certain time. The objective is to establish the frequency of the heartbeat, the type of heart rhythm and morphology of the electrical waves of the heart. It may show enlargement or distention of the right ventricle.

Blood collection tube

Analytical determinations. These help determine the cause of pulmonary arterial hypertension. Liver and thyroid function studies are done, serology for HIV and hepatitis B and C viruses, as well as analysis of antibodies associated with connective tissue diseases.

Monitor with an echocardiogram

Echocardiogram. This provides a non-invasive estimation of pulmonary artery pressure, by assessing the properties of the right heart chambers, and ruling out heart disease as the origin of pulmonary hypertension. Therefore, this is the technique most often used in the detection of pulmonary hypertension.

Image of a ventilation and perfusion lung scan

Ventilation and perfusion lung scan. This measures the flow of air in the lungs (ventilation) and shows how the blood circulates in the lungs (perfusion). It must be done in all patients to rule out thromboembolic disease.

Person who gets a pulmonary function tests

Pulmonary function tests. To evaluate how pulmonary hypertension affects lung function. It can also detect respiratory disease as the cause of the appearance of pulmonary hypertension.


Chest computed tomography (CT) scan. This is recommended when lung tissue involvement is suspected. This is the case with interstitial lung disease, veno-occlusive disease and pulmonary capillary haemangiomatosis. Contrast CT angiography, or Computed Tomography Angiography, can locate and quantify thromboembolic lesions.

Person with electrodes at a running appointment performing a stress test

Exercise stress tests. These evaluate the limitation of the patients' aerobic capacity (ability to do moderate exercise). The objective measurement of exercise tolerance can be done with simple tests, such as the 6-minute walk test, or complex tests, such as cardiopulmonary exercise tests on a cycle ergometer.

Image of the heart indicating the performance of a pulmonary hemodynamic study

Pulmonary haemodynamic study. This is the tool that confirms the diagnosis of pulmonary hypertension and provides information on its severity and prognosis. It can also assess whether the disease is reversible, and to what degree, through the acute vasodilator test.

Substantiated information by:

Isabel Blanco Vich
Joan A. Barberà Mir

Published: 23 November 2021
Updated: 1 December 2021

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