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Summary and Explanation of Common Tests for Pulmonary Hypertension

Consensus Statement
Issued by the Scientific Leadership Council

DISCLAIMER:
This information is for general information only. These guidelines may not apply to your individual situation. You should rely on the information and instructions given specifically to you by your PH specialist and/or the nurses at your PH Center. This information is general in nature and may not apply to your specific situation. It is not intended as legal, medical or other professional advice, and should not be relied upon as a substitute for consultations with qualified professionals who are familiar with your individual needs.

Imaging (Noninvasive) Tests 

Chest X-ray – a large photographic picture of the heart and lungs. It is used to determine if pneumonia or lung scarring is present, if the heart and pulmonary arteries are enlarged, and if there is fluid in the lungs.

V/Q (Ventilation/Perfusion) scanning – a special test to look for blood clots in the lungs. This test uses radioactive materials given in the veins and inhaled in the lungs. A completely normal scan effectively excludes clots in the lungs.

CT (CAT) scanning – a special X-ray of the body, providing more detailed images than a chest x-ray. It is used to examine the heart and lungs in detail. It may also be used to look for blood clots in the lungs.

Cardiac MRI (magnetic resonance imaging) – a special non-X-ray imaging technique that, among other uses, can accurately measure right ventricular chamber volumes and function.  Many MRI scanners involve being in a relatively enclosed space; patients with claustrophobia may not tolerate them or may require some sedation to improve comfort during the scan.  Certain devices such as pacemakers are generally not compatible with MRI testing due to the magnetic field generated during the scan.

Echocardiogram – a specialized ultrasound of the heart. It is used to take pictures of the heart muscle, heart valves, and to estimate pulmonary artery (PA) pressure.

Invasive Testing

Cardiac catheterization

Right Heart Catheterization – This is the "gold standard" test for confirming PAH. A catheter is placed into the veins and advanced into the pulmonary arteries to measure pressures in the right side of the heart and the lungs, and cardiac output (the amount of blood that the heart pumps).

Left Heart Catheterization This test is done to measure pressures in the left side of the heart and to take pictures of the heart and the arteries of the heart (coronary arteries).

Pulmonary Angiogram – Dye is injected into the pulmonary arteries while X-ray pictures are taken. This is the "gold standard" test to identify clots in the lungs.

Laboratory Testing

Blood Testing for:

  • Electrolytes (sodium, potassium, etc)
  • Kidney Function (creatinine, Blood urea nitrogen)
  • Liver Function e.g. Alkaline phosphatase, AST
  • Thyroid Function (e.g. sTSH, total or free thyroxine)
  • ANA - Antinuclear antibody, a screening test for suspected connective tissue (autoimmune) disease

HIV Testing

BNP: Brain natriuretic peptide – A small protein made by the heart; elevated levels may suggest development or presence of impaired right ventricular function.

N-BNP – N-terminal brain natriuretic peptide. Parent protein for BNP; circulates in the blood in higher levels than BNP and elevated levels may also signal presence of pulmonary hypertension and right ventricular impairment.

Pulmonary Function Testing – breathing tests to determine airway (lung) function

Electrocardiogram (EKG) – noninvasive measurement of electrical activity in the heart, to look for heart damage and/or abnormal heart rhythms

Exercise Testing

6-Minute Walk Test – measures how far a person can walk in 6 minutes; used to provide an estimate of exercise capacity

Treadmill Test – measures how long a person can walk on a treadmill with increasing speed and incline; a more formalized way to determine exercise capacity

Cardiopulmonary Exercise Testing – measurements of heart function and lung gas exchange (oxygen, carbon dioxide) performed while exercising on a treadmill or bicycle.

 

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