Diagnosing Pulmonary Arterial Hypertension Requires an Invasive Right Heart Catheterization

Abstract

A 42-year-old woman described worsening chest pain and New York Heart Association II-III dyspnea. Her medical history included obesity, obstructive sleep apnea treated with continuous positive airway pressure, hypothyroidism, depression, and hypertension. Electrocardiogram showed sinus tachycardia with right heart strain (Figure 1A). Her brain natriuretic peptide level was 869 pg/mL. Chest x-ray revealed central pulmonary artery prominence. Echocardiogram showed an ejection fraction (EF) of 61% and peak estimated pulmonary artery (PA) pressure of 50 mm Hg.