Diagnosis of Pulmonary Hypertension

Diagnosis of pulmonary arterial hypertension (PAH) is generally challenging due to nonspecific symptom presentation and several potential contributing conditions. Timely diagnosis of PAH is very important as the disease is progressive in nature and associated with increased morbidity and mortality. Therefore, the implementation of appropriate strategies that can reduce the delay in diagnosis of PAH, increase awareness among primary healthcare practitioners, and expedite referral to PAH specialists, are very crucial.

Patients with systemic sclerosis, human immunodeficiency virus, heritable disease, portal hypertension, and congenital heart disease are at highrisk of developing PAH. A definitive screening test is recommended for patients with these high-risk conditions to reduce the time to diagnosis. The diagnosis of pulmonary hypertension begins with a clinical suspicion generally based on symptoms, which is followed by physical examination of the patient and evaluation of haemodynamic criteria.

Integration of a high index of clinical suspicion with any expected abnormalities in basic diagnostic tests, substantially increases the likelihood of early diagnosis of PAH. The diagnostic tests required in the clinical assessment of suspected cases of PAH can be broadly categorised as essential diagnostic tests and additional diagnostic tests. The essential tests required in the diagnosis of PAH include electrocardiography, haematological testing, pulmonary function tests, echocardiography, ventilation-perfusion scan of the lungs, computed tomography scan, right heart catheterisation, genetic testing, and advanced imaging testing.

This article is an attempt to provide guidance to healthcare professionals in the clinical decision-making process for the diagnosis of PAH, which would benefit patients as PAH is progressive in nature.