Fast Five Quiz: Pulmonary Arterial Hypertension Presentation and Diagnosis

Vikramjit Khangoora, MD


May 17, 2022

The most important screening tool in symptomatic patients with a suspicion of pulmonary hypertension is the TTE. TTE evaluates the probability of pulmonary hypertension using the tricuspid regurgitant jet velocity, right ventricle size, wall thickness, and function, and the potential involvement of left-sided heart disease. Right-sided cardiac catheterization is necessary to confirm the diagnosis.

ECG can provide reliable clues to the presence of pulmonary hypertension; however, a normal ECG does not exclude the diagnosis of PAH. ECG features that suggest pulmonary hypertension and right ventricular function have been associated with a worse prognosis.

Following confirmation of pulmonary hypertension, further studies should be performed to determine the etiology. PAH is a diagnosis of exclusion; European guidelines recommend evaluating for WHO group 2 or 3 disease with pulmonary function tests, arterial blood gases, and chest imaging. If inconclusive, ventilation-perfusion lung scanning is performed to exclude group 4 disease.

Learn more about PAH.


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