Diagnosis and evaluation of the patient with pulmonary hypertension.

The term pulmonary hypertension is as imprecise as the term heart failure. Elevation in pulmonary arterial pressure can be caused by heterogeneous processes with profoundly different treatment implications. Pulmonary hypertension can present at any age and across all demographic ranges. Despite major advances in pathogenesis and treatment for pulmonary arterial hypertension, the diagnosis of this life-threatening but treatable condition often remains delayed and incomplete. Because the presenting symptoms of pulmonary hypertension are nonspecific, a high index of suspicion is required for timely recognition. Accordingly, suspecting or recognizing pulmonary hypertension remains the first and critical hurdle in the diagnosis of pulmonary hypertension. This article reviews the stepwise approach necessary for an efficient and accurate diagnosis of pulmonary hypertension.