Diagnostic Tests & Procedures
The start of symptoms in pulmonary hypertension can be subtle and often patients and their physicians may not recognize that they have a serious medical condition. Pulmonary hypertension can thus be difficult to diagnose. In addition, symptoms are nonspecific and may include, but are not limited to, shortness of breath, fatigue, chest discomfort, syncope, and palpitations.
At Stanford, the initial evaluation of each patient begins with review of any previous medical evaluations and a comprehensive history and physical examination. During the initial consultation, a Stanford Pulmonary Hypertension faculty physician together with the patient and their family will review diagnostic and therapeutic options. Generally, several diagnostic tests are required to diagnose pulmonary vascular disease and help ascertain its cause. The most common tests, all of which may be performed at Stanford Hospital and Lucille Packard Children’s Hospital in state-of-the art facilities, include the following:
Comprehensive Blood Tests
Comprehensive Blood Tests
Blood testing is used to evaluate for possible underlying diseases such as underlying liver disease, certain connective tissue diseases, HIV, among others.
Chest X-ray
Chest x-ray
A chest x-ray is a simple image of the chest which shows the basic anatomy of the heart and lungs and can be used to diagnose certain lung conditions associated with pulmonary vascular disease. This may not be necessary for those undergoing a CT scan of the chest.
EKG
EKG
An EKG is a measurement of the electrical activity of the heart and abnormalities in an EKG may show certain types of stress on the heart or abnormal heart rhythms.
Echocardiogram
Echocardiogram
An echocardiogram is a non-invasive test that uses sound waves to show the anatomy and function of the heart. This is a key initial screening test for pulmonary hypertension. With this test, an estimate of the lung blood pressure and assessment of the right heart function, which is often abnormal in pulmonary hypertension, can be made. The echocardiogram can also be used to diagnose other heart dysfunction or congenital heart.
Pulmonary Function Tests (PFT)
Pulmonary Function Tests (PFT)
Pulmonary function tests measures of the airflow in the lungs and the overall lung volumes and is used to help diagnose any underlying lung disease. While breathing through a mouth piece, patients are asked to perform certain breathing maneuvers that are measured by a computer.
Six-minute Walk Test
Six-minute Walk Test
This is a test in which a patient walks for six minutes while being monitored by a technician. The distance covered, oxygen levels, heart rate, blood pressure, and your level of breathlessness are recorded. The test can be performed with or without supplemental oxygen.
Ventilation-Perfusion Scanning (V/Q scan)
Ventilation-Perfusion Scanning (V/Q scan)
A V/Q scan is a nuclear medicine imaging test that shows the pattern of air flow (the V part) and the pattern of blood flow (the Q part) in the lungs. This is useful in determining whether or not a patient has large blood clots in their lungs.
Computerized Axial Tomography (CT Scan)
Computerized Axial Tomography (CT Scan)
A CT scan of the chest is an imaging test can detect lung disease that may be missed on a chest x-ray and is an important tool in providing detailed anatomy of the heart, lungs, and surrounding blood vessels. CT angiography can also be used to diagnose blood clots in the lungs.
Cardiac Catheterization
Cardiac Catheterization
Cardiac catheterization is the gold standard for diagnosing pulmonary hypertension and has an important role in the classification of PH . This is an invasive procedure which is is performed by advancing a plastic catheter through a large vein in the neck, leg, or arm and into the heart where direct measurement of pressures in the right side of the heart and the pulmonary arteries can be made. More Congenital heart defects may also be identified during a cardiac cath. Often, additional diagnostic tests are performed including testing with drugs that dilate the blood vessels in the heart (vasodilator testing), exercise testing, or angiograms are done during a cardiac catheterization to further clarify the classification of PH and may guide the choice of therapy in each patient.
Polysomnography
(Sleep Study)
Polysomnography (Sleep Study)
The test consists of recording a number of physiologic parameters while a patient sleeps and is used to diagnose sleep related breathing disorders such as obstructive sleep apnea Many different activities are monitored by the polysomnograph during a sleep study. These include brain waves (EEG), eye movements (EOG), muscle activity (EMG), heartbeat (EKG), blood oxygen levels and respiration. Each of these activities is represented by graphical tracings on a polysomnogram.
Learn more: Overnight Sleep
Home Sleep Study
Cardiopulmonary Exercise Test
Cardiopulmonary Exercise Test
This test measures endurance and the ability of the patient's heart and lungs to compensate during physical activity. Multiple measurements of your heart and lung function are monitored while you walk on a treadmill or ride an exercise bike. This test is performed in only select patients with PH.
Cardiac MRI
Cardiac MRI
This is a specialized imaging test that produces very clear images of the heart. This is used to assess heart function and is particularly helpful for determining whether there is a congenital heart defect. This test is performed only in select patients with PH.