Pulmonary hypertension screening

Pulmonary Hypertension Microchapters
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Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Pulmonary hypertension from other Diseases
Epidemiology & Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Study of Choice
History & Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Diagnostic Studies
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Assistant Editor(s)-in-Chief: Ralph Matar,

Screening

Patients who are considered at high risk for the development of pulmonary hypertension and require periodic screening include:

• Those with a known BMPR2 mutation(Associated with Familial Pulmonary Hypertension).
• Those with Scleroderma spectrum of diseases.
• Those with portal hypertension who are undergoing evaluation for liver transplantation.

The best study for screening patients suspected of having pulmonary hypertension based on history, physical examination, chest x-ray (CXR), and electrocardiogram (ECG) is an Echocardiogram.

These are the parameters that should be evaluated on Echocardiogram:

1. Right atrial and right ventricular enlargement.
2. Reduced right ventricular function.
3. Displacement of the interventricular septum.
4. Tricuspid regurgitation(TR).
5. Tei index or myocardial performance index (measured by doppler Ultrasound).
6. Pericardial effusion (presence also indicates a higher mortality rate).

The Tei index is an index of combined right ventricular systolic and diastolic function obtained by dividing the sum of both isovolumetric contraction and relaxation intervals by the ejection time.

Evaluation for thromboembolic disease is also appropriate in all patients suspected of having Pulmonary Hypertension.