A 40-year-old woman has been complaining of a 3-year history of increasing dyspnea and fatigue. She has no other medical illness. Physical examination reveals increased jugular venous pressure (JVP) with prominent c-v wave, and a reduced carotid pulse. Precordial examination reveals a left parasternal lift, loud P2, and right-sided S3 and S4. There are no audible murmurs. CXR reveals clear lung fields and an ECG shows evidence of right ventricular hypertrophy. Pulmonary function tests show a slight restrictive pattern. Primary pulmonary hypertension is suspected. Which of the following is the most appropriate test to confirm the diagnosis?
Open lung biopsy is not required. Pulmonary angiography is usually performed only if a lung scan suggests thromboembolic disease. Cardiac catheterization is useful to exclude an underlying cardiac shunt as the cause of the pulmonary hypertension. The pulmonary capillary wedge pressure is normal but can be difficult to obtain.
open lung biopsy
pulmonary angiography
cardiac catheterization
noninvasive exercise testing
Respiratory