Pulmonary Hypertension: When to Get Accurate Testing?

Do I have pulmonary hypertension? Would a CT scan provide a more accurate diagnosis?

I have recently been experiencing episodes of shortness of breath to the point where I can hardly walk.
Whether I am walking or climbing stairs, I feel like I can't catch my breath, and it has become quite severe.
Whenever I exercise, my heart feels weak, and I become so breathless that I feel like I want to hit the wall.
Especially when I eat in hot and humid places, I start to experience intense palpitations, and my heart feels like it is pounding so hard it might explode.
I become very breathless and fatigued, similar to symptoms of heart disease, and I feel like my heart is skipping beats.
I am completely unable to walk.
Later, I took a friend's heart medication (Dipyridamole), and after taking it, my heart didn't pound as hard, and I didn't feel as breathless as before.
I went to a clinic to get an echocardiogram, and the doctor said my pulmonary artery pressure was only 22 mmHg.
However, the doctor mentioned that if I am not having an episode, the echocardiogram results for pulmonary hypertension may not be accurate and that it would be more useful to measure it during an episode.
Is it true that if I have pulmonary hypertension, it would be more accurate to measure it during an episode? Some doctors have suggested that I undergo a CT scan, while others say that a cardiac catheterization is necessary to determine the condition.
Which method is more effective for diagnosing this issue?

He Tong, 40~49 year old female. Ask Date: 2022/10/23

Dr. Wu Xueming reply Cardiology

A measurement of 22 mmHg does not meet the diagnostic criteria for pulmonary hypertension.

Reply Date: 2022/10/23

More Info

Pulmonary hypertension (PH) is a serious condition characterized by elevated blood pressure in the pulmonary arteries, which can lead to significant cardiovascular complications. Your symptoms of shortness of breath, especially during physical activity, and the sensation of a racing heart, are concerning and warrant further evaluation.
In your case, the fact that you experience severe breathlessness and palpitations, particularly in hot environments, suggests that your body is struggling to meet the oxygen demands during exertion. This could be indicative of underlying cardiovascular issues, including pulmonary hypertension or other cardiac conditions.
Regarding your question about testing for pulmonary hypertension, it is important to understand that the diagnosis of PH typically involves several steps. While echocardiography (heart ultrasound) is a common initial test to estimate pulmonary artery pressure, it is not always definitive. The measurement of pulmonary artery pressure via echocardiography can be influenced by various factors, including the patient's condition at the time of the test. Therefore, if you are not experiencing symptoms during the test, the results may not accurately reflect your resting pulmonary artery pressure.

Your doctor mentioned that the echocardiogram showed a pressure of 22 mmHg, which is considered normal. However, if you are experiencing episodes of significant symptoms, it may be beneficial to conduct the echocardiogram during these episodes to obtain a more accurate assessment of your pulmonary pressures. This is because the pressures can fluctuate based on your activity level and overall condition at the time of testing.

In addition to echocardiography, other diagnostic tools can provide more definitive information about pulmonary hypertension. A right heart catheterization is the gold standard for diagnosing PH, as it directly measures the pressures in the pulmonary arteries. This invasive procedure involves threading a catheter through a vein into the right side of the heart and into the pulmonary artery. It provides accurate measurements of pulmonary artery pressure and can help determine the severity of the condition.

CT pulmonary angiography can also be useful, particularly if there is a suspicion of pulmonary embolism or other structural abnormalities in the lungs or pulmonary vasculature. This imaging technique can visualize the blood vessels in the lungs and assess for any blockages or abnormalities that may contribute to elevated pressures.

In summary, while echocardiography is a useful initial screening tool for pulmonary hypertension, it may not always provide a complete picture, especially if the patient is asymptomatic at the time of the test. If you are experiencing significant symptoms, it is advisable to discuss with your healthcare provider the possibility of conducting the echocardiogram during an episode or considering more definitive testing, such as right heart catheterization or CT pulmonary angiography.
It is crucial to address your symptoms promptly, as untreated pulmonary hypertension can lead to serious complications, including heart failure. Please consult with a cardiologist who can evaluate your symptoms in detail and recommend the most appropriate diagnostic tests and treatment options based on your specific situation.

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