Early diagnosis of pulmonary hypertension and its peculiarities

Iveta Idzelytė1, Karolina Slapšytė1

1Lithuanian University of Health Sciences, Faculty of Medicine


Pulmonary hypertension (PH) is a pathophysiological disorder characterized hemodynamically as an increase in mean resting pulmonary artery pressure of at least 25 mm Hg, as determined by right cardiac catheterization. The etiology of PH is multifaceted, with hereditary cases mostly associated with the BMRP2 mutation, and clinically most commonly identified idiopathic PH or PH associated with connective tissue disease. The most complex PH diagnosis is when it does not meet one PH group but meets criteria that overlap between several groups. The determination of PH depends on a detailed medical history, clinical signs, and thorough physical examination. Patients with PH complain of unclear progressive dyspnea, decreased exercise tolerance, angina pectoris, syncope, and may experience premature death due to right ventricular failure. Laboratory findings are not usually specific but may help identify the clinical type of PH, such as the presence of antinuclear antibodies in scleroderma. In early PH diagnostics, type B natriuretic peptides (BNPs) and N-terminal pro-type natriuretic peptide (NT-pro BNPs) are less important. Lung function tests are not relevant in the diagnosis of PH because they indicate primary lung disease and PH is a secondary lung disease and can therefore only be used for differential diagnosis. The 6-minute walk test can be used to monitor PH progress and assess the physical condition, but not for a diagnosis. Echocardiography is used for PH screening and is a sensitive and specific test method for determining PH. In this study, right atrial and ventricular enlargement, right ventricular hypertrophy, abnormal interventricular septal contraction, left ventricular diastolic dysfunction and decreased left ventricular size and it’s capacity during systole and diastole can be identified. Doppler examination also confirms the regurgitation of the tricuspid valve. ECG shows right ventricular hypertrophy, changes in chest radiograph are also seen.


Keywords: pulmonary arterial hypertension, pulmonary hypertension, diagnosis, echocardiography,  right ventricular failure.