Pulmonary hypertension diagnostic study of choice

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Pulmonary Hypertension Microchapters


Patient Information


Historical Perspective




Differentiating Pulmonary hypertension from other Diseases

Epidemiology & Demographics

Risk Factors


Natural History, Complications and Prognosis


Diagnostic Study of Choice

History & Symptoms

Physical Examination

Laboratory Findings


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Echocardiography or Ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1], Richard Channick, M.D.; Assistant Editor(s)-in-Chief: Ralph Matar, Lisa Prior, Ann Slater, R.N.; José Eduardo Riceto Loyola Junior, M.D.[2]


Pulmonary hypertension is defined by a mean pulmonary arterial pressure higher than 25mmHg. It can be assessed by echocardiography, the diagnostic study of choice due to its low risk and useful information that it can provide, and right heart cardiac catheterization to confirm the diagnosis.


Diagnostic Study of Choice

  • Echocardiography is the diagnostic study of choice, as it can:
    • Estimate the pulmonary artery systolic pressure (PSAP);
    • Evaluate for possible causes of pulmonary hypertension;
    • Assess the presence of right atrial or ventricular enlargement, hypertrophy, or decreased right ventricular function;
    • May also evaluate left heart chambers, especially if they are causing pulmonary hypertension;
  • Although pulmonary arterial pressure can be estimated on the basis of echocardiography, pressure sampling with a Swan-Ganz catheter provides the most definite measurement. PAOP and PVR cannot be measured directly with echocardiography.
  • Therefore the diagnosis of PAH requires a cardiac catheterization. A Swan-Ganz catheter can also measure the cardiac output, which is far more important in measuring disease severity than the pulmonary arterial pressure.
  • Normal pulmonary arterial pressure in a person living at sea level has a mean value between 12 and 16 mm Hg. Definite pulmonary hypertension is present when mean pressures at rest exceed 25 mm Hg. If mean pulmonary artery pressure rises above 30 mm Hg (4000 Pa) with exercise, that is also considered pulmonary hypertension.

Diagnostic criteria

A diagnosis of PAH requires the presence of pulmonary hypertension with two other conditions.

  • Pulmonary artery occlusion pressure (PAOP or PCWP) must be less than 15 mm Hg (2000 Pa)
  • Pulmonary vascular resistance (PVR) must be greater than 3 Wood units (240 dyn•s•cm-5 or 2.4 mN•s•cm-5).


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  8. Kawut SM, Silvestry FE, Ferrari VA; et al. (1999). "Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension". Am. J. Cardiol. 83 (6): 984–6, A10. PMID 10190427. Unknown parameter |month= ignored (help)
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  10. Galiè N, Hoeper MM, Humbert M, Torbicki A, Vachiery JL, Barbera JA; et al. (2009). "Guidelines for the diagnosis and treatment of pulmonary hypertension: the Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS), endorsed by the International Society of Heart and Lung Transplantation (ISHLT)". Eur Heart J. 30 (20): 2493–537. doi:10.1093/eurheartj/ehp297. PMID 19713419.
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