An electrocardiogram should be performed which will show enlargement of the right side of the heart.
A chest X-ray may show enlargement of the size of the heart, and is often a good way to follow the patient's heart size over time.
An echocardiogram, or ultrasound of the heart, will be performed initially and can also be used to follow the progression of the disease. An echo can show enlargement of the right ventricle and can sometimes estimate the pressures of the right ventricle and pulmonary arteries.
A six-minute walk test is used to evaluate the exercise capacity of an individual with pulmonary hypertension, and the subsequent response to therapy. During this test an oxygen saturation monitor (pulse ox) is placed on the side of the head (temple), and the patient walks along the measured course at their own pace for six minutes. The total distance walked is then calculated and compared with previous six-minute walk tests.
The gold standard for making the diagnosis of pulmonary hypertension is a cardiac catheterization. This will actually measure the pressures on the right side of the heart and the resistance of the blood vessels in the lungs. Various drugs may be used during a cardiac catheterization to determine if the blood vessels in the lungs will relax in response to them. This may lower the pressures in the lungs and can help guide therapy.