Pulmonary Hypertension

In the early stages of the disease, a patient’s physical examination results may appear almost normal. To establish a diagnosis, doctors may order a series of tests to measure the lung pressure and the function of the patient’s heart and lungs. These tests are done at the same time to accurately narrow down the heart condition(s) causing the symptoms.

• ​Chest X-Ray (of the heart and lungs)
• Electrocardiogram
• Echocardiogram (an ultrasound of the heart to help determine its structure and how well it functions)
• Right-heart catheterisation (the cardiologist inserts a special tube through a vein into the heart and lung vessels to measure the lung pressure and test how well the heart is pumping)
• Lung/pulmonary function tests (to measure lung function)
• Perfusion lung scan (an imaging of blood flow through the lungs)
• Six-minute walk test (a measurement of how far a patient can walk within six minutes)

How serious is pulmonary hypertension?

Even though there is no known cure for or prevention against pulmonary hypertension, the condition is still treatable.

According to the American Lung Association, approximately 50 per cent of people diagnosed with pulmonary hypertension die within five years. For those whose condition is left untreated, the average survival is shortened to about three years.

Even with treatment, the high blood pressure in the lung arteries will continue to worsen and make daily activities more difficult. Adopting lifestyle modifications, however, may help patients with pulmonary hypertension get through their daily routine.

Cardiologists refer to the World Health Organization (WHO) Functional Classification to identify the severity of pulmonary hypertension in patients and decide on suitable treatments.

Functional status is a person’s ability to perform daily activities and is ranked from Class I (no limitations) to Class IV (unable to perform any physical activity). Below are the brief descriptions of the four NYHA functional classes.

• WHO Class I: No limitation of usual physical activity; ordinary physical activity does not cause increased breathing problems, fatigue, chest pain or lightheadedness.
• WHO Class II: Mild limitation of physical activity; there is no discomfort when at rest, but normal physical activity causes increased breathing problems, fatigue, chest pain or lightheadedness.
• WHO Class III: Marked limitation of physical activity; there is no discomfort when the person is at rest, but less than ordinary physical activity causes increased breathing problems, fatigue, chest pain or lightheadedness.
• WHO Class IV: Unable to perform any physical activity and possible signs of heart failure in the right ventricle (the heart chamber that pumps blood to the lungs); at rest, patients have difficulty breathing and/or fatigue, and symptoms get worse with almost any physical activity. History of fainting will place patients in NYHA Class IV even if their limitations in activity is categorised under NYHA Classes II or III.