Keeping Track of Your Pulmonary Arterial Hypertension

If you have pulmonary arterial hypertension (PAH), it’s possible to lead an active, productive life. The key is to work closely with a specialist, usually a lung doctor (pulmonologist) or a heart doctor (cardiologist).

“The cardiologists who do this have an appreciation for the effect on the lungs, and the pulmonologists who do it have an appreciation for the impact on the heart. There are a lot of wonderful specialists,” says Jamie Garfield, MD, a pulmonologist and associate professor of thoracic medicine and surgery at Temple University.

Because PAH is a condition that can get worse over time, it’s important to get certain medical tests every few months. These help your doctor understand how well your treatments are working or if they’re not.

“This disease is not like one and done: You don’t just come in, you get started on a pill, and you’re done,” Garfield says.

Two exams your specialist might order are the 6-minute walk test and the echocardiogram.

What Is a 6-Minute Walk Test?

The goal is simply to walk as far as you can at a normal pace for 6 minutes. The course you walk on is a flat, hard surface indoors, and it can be as basic as a 100-foot hallway with a chair or cone that you pace back and forth to.

“You walk around a set course for 6 minutes, and we monitor how your oxygen level handles that walk and what happens to your heart rate,” Garfield says.

Your blood pressure, pulse, and oxygen level are measured before you begin walking. You’ll be asked to rate how tired you feel and if you’re having any trouble breathing.

Once you start walking, the person giving you the test will let you know how much time is left after each minute goes by. It’s OK to slow down, rest, or stop at any point. Let them know if you have any symptoms, like chest pain or trouble breathing. They’ll be ready to help you right away if you need it.

After the 6 minutes are up, they’ll ask you again to rate your breathing and fatigue level, and they’ll measure how far you walked. They may measure your oxygen level and check your pulse again, too.

What Is an Echocardiogram?

It’s an imaging test that uses sound waves to see inside your body and give your doctor a look at your heart.

“It’s similar to an ultrasound that you use on pregnant women,” Garfield says. “An echocardiogram shows us the size of the heart, the chambers of the heart, and the flow of the blood through these chambers. Most importantly, we can use it to measure pressure in the heart and in the pulmonary arteries.”

Before the test, you’ll take off your clothes from the waist up and put on a hospital gown. A technician will put three small, sticky patches called electrodes on your chest. These are attached to a monitor that tracks your heart’s electrical activity during the exam. The technician might also have you wear a mask that tracks how well your heart and lungs use oxygen and carbon dioxide.

They may have you lie on your left side on an exam table. But some people get an echocardiogram while pedaling a stationary bike or walking on a treadmill.

How Does Your Doctor Use Your Test Results?

If the results of a 6-minute walk test or echocardiogram show that your PAH is getting worse, the doctor may change your treatment plan. Depending on your specific situation, they might:

• Change medications
• Talk with you about other treatment options if meds aren’t helping enough
• Send you to the hospital if a test spots serious problems

Your doctor might also recommend more tests, like right-heart catheterization, Garfield says. Doctors usually use this test to help diagnose the condition, she says, but they may need to do it again if other tests show your PAH is getting worse.

Right-heart catheterization is when your doctor puts a small, thin, flexible tube called a catheter into a large vein, usually in your neck or groin.

“We thread that catheter through the blood vessels until we reach the heart, and in the heart we’re able to measure pressures,” Garfield says.

Before the procedure, your doctor gives you medicine that numbs the body part where the catheter goes in. You’ll lie down on a table during the procedure and stay awake. During right-heart catheterization, your doctor may ask you to do things like hold your breath, bear down, and cough. This all takes about an hour.

As you’re getting tests to track your pulmonary arterial hypertension, keep going to all your follow-up appointments, and be sure to tell your doctor how you’re feeling.