Diagnosis of pulmonary hypertension

Background: Pulmonary hypertension (PH) is an abnormal increase in pulmonary pressures that may occur in the setting of known disease or from an unidentifiable cause. The most common presenting symptoms are dyspnea and fatigue; however, the average delay between symptom onset and final diagnosis remains close to 2 years. A definitive diagnosis of PH relies on the presence of elevated pressures during right heart catheterization. Nonetheless, several more diagnostic tests are available that contribute to the evaluation of these patients. The clinical history and physical examination, chest roentgenogram, electrocardiogram, transthoracic echocardiogram and pulmonary function tests are all useful modalities in the early evaluation of possible PH. Some contributory illnesses, such as connective tissue diseases or human immunodeficiency virus infection, can be detected serologically. Finally, more advanced imaging may be warranted depending on the suspected etiology of PH. Objective: To review the various diagnostic modalities in the evaluation of individuals with PH. Method: A comprehensive review of the PubMed literature database was performed. Conclusion: The diagnostic evaluation of PH requires not only detecting elevated pulmonary arterial pressures, but also identifying any underlying etiology and characterizing the severity of the disease. Multiple invasive and non-invasive modalities are combined to achieve this goal.