Pulmonary hypertension, also called coronary artery disease or myocardial ischemia, refers to the increased pressure inside the heart muscles, arteries and veins. This pressure can increase without a heartbeat being felt as the vessels enlarge and form blood clots. Pulmonary hypertension, which often develops over a period of time, can be due to many factors, such as smoking, high blood pressure, prior disease or other cardiac problems, or even asthma. As it can be difficult to diagnose, many people who are at risk for developing this condition are not even aware that they have it.
Pulmonary hypertension is diagnosed by a physician using the following four factors: systolic blood pressure (the maximum blood pressure during the peak attack of heart contractions), aortic blood pressure, a fasting echocardiogram and a pulmonary function test called the echocardiography study or the beta-yleoid index. The first factor, systolic blood pressure, indicates the highest blood pressure while the second factor, aortic blood pressure, indicates the lowest blood pressure at the point of maximal heart contraction. The third factor, aortic blood pressure, indicates the pressure at the heart’s center in extension. The fourth factor, pulmonary function test, indicates the ability of the lungs to transport gases and air into the body and function normally. Having these pulmonary hypertension criteria measurements done at the same time and in the same setting is the best way to diagnose mild to moderate pulmonary hypertension.
Baseline evaluation procedures include a detailed physical exam, spirometry, electrocardiogram, blood chemistry profile, chest pain and a few other tests. Each of these is designed to identify the main cause of the condition so that treatment can be started early. In addition to the physical examination, an echo-locator procedure called the thoracic interbody imaging system (THI) is conducted. This procedure provides images of the upper respiratory tract and various parts of the chest. It is important to have a normal chest image so as to determine whether there are any undue dyspareunia or signs of asthma, heart failure, or other conditions that need to be considered.
During the first week of testing, a complete blood count with normal or low volume is conducted, chest x-ray, urinalysis, bone mineral density and vital sign tracking are performed. A physician may choose to do a late indicator test such as the digital pleural fluid analysis (DFA) or the pulmonary hypertension specific test (HSPT). During the month of October, a final blood count and/or EKG is conducted to determine the end stage of the disease. The month of November is also a good month for monitoring as it is typically the last month of acute dyspnea and the normal catecholamine levels are returning to normal. The clinical goals are to confirm the dysparesis as dyspnea and then plan treatments based on the diagnosis.
Pulmonary hypertension has specific triggers and precipitating factors and is therefore very specific in determining criteria for who is at risk and how to intervene. Each of these categories has specific risk factors and time frames to evaluate: The history of smoking; weight; body frame; height; gender; health status; daily or weekly physical activities or exercise status; family medical history; and role limitations due to sleep apnea. As each of these health status and sleep apnea risk factors is determined, interventions can be tailored to the individual patient according to their specific needs. Intervention plans are then developed and implemented.
The physical examination is the starting point for evaluating the patient’s general health status. The pulmonary hypertension specific screening test is then performed to assess the dysparesis. The blood pressure is measured at three different times: on the morning, during the afternoon, and at night. These three measurements allow the physician to evaluate the changes in the blood pressure over time as it varies with the different phases of the day. The purpose of this step is to provide the clinician with a comprehensive picture of the patient’s cardiovascular and pulmonary function at all times.
The clinical characteristics of the patient are then evaluated based on the clinician’s findings during the previous visit. A summary of the progress is presented in a rating that ranges from “fair” to “very poor”. The criteria for evaluating the patient’s health state on a score index also known as the EQ-5D includes the following components: physical function, vital signs, laboratory findings, and role limitations due to sleep apnea. Additional ratings are given in the EQ-5D to evaluate improvement or worsening of the patient’s health state. For these criteria, a separate index is used to evaluate the progress over time, called the delta rating, when changes in other aspects of the patient’s health are measured.
A numerical value is given to indicate the improvement or deterioration in a patient’s health during the past six months. The changes from the time frame of the baseline period to the time frame of the latest improvement represent the delta rating. The total score is the sum of the difference scores over the six month period. Changes from the baseline period are calculated as the difference from the current month’s value to the previous month’s value. A patient may have to meet more criteria to reach the level of pulmonary hypertension designated as “fair” or “poor.”