Chest radiology
- may show right atrial dilatation and right ventricular enlargement; pulmonary arteries are normally prominent in this condition with peripheral pruning.
ECG
- right ventricular hypertrophy; right axis deviation, R wave in V1, inverted T waves in right precordial leads. There may be right bundle branch block and tall, peaked P waves in lead II (P pulmonale).
Echocardiography
- demonstrates a dilated right ventricle with impaired function and often provides the first evidence of pulmonary hypertension. Pulmonary artery pressure can be estimated from the tricuspid regurgitant jet
Cardiac catheterization
- right heart catheterisation is mandatory for establishing the diagnosis, defined by the mean pulmonary artery pressure. Cardiac output and pulmonary vascular resistance is calculated and oxygen saturation measured in each chamber. The data from right heart catheterisation is used to assess prognosis and determine a treatment plan
- defined by a mean pulmonary artery pressure of > =25 mmHg at rest
Other investigations are directed towards causes of pulmonary hypertension, e.g. chronic pulmonary emboli, valvular disease, chronic lung disease.
Imaging
- Ventilation/perfusion scans will show mismatched defects in chronic thromboembolic pulmonary hypertension. CT and MRI demonstrate enlargement of the pulmonary arteries and right sided cardiac chambers
Reference:
- 1) British Heart Foundation (August 2012). Factfile: pulmonary hypertension