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Pulmonary Arterial Hypertension — RACP Adult Medicine MCQ

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ModerateRespiratoryPulmonary Arterial HypertensionRACP Adult Medicine

A 40-year-old woman presents with worsening breathlessness on exertion. She has a loud P2 on auscultation. Echocardiography estimates pulmonary artery systolic pressure at 65 mmHg with dilated right ventricle. What investigation is required to confirm the diagnosis of pulmonary arterial hypertension?

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Correct answer: C — Right heart catheterisation

Elevated pulmonary pressures on echocardiography are suggestive but not diagnostic of pulmonary hypertension. Right heart catheterisation is mandatory to confirm the diagnosis (mean PAP ≥20 mmHg at rest, PCWP ≤15 mmHg for pre-capillary PH, PVR ≥2 Wood units). It also guides classification and treatment decisions. V/Q scan should be performed to exclude CTEPH. Full workup includes PFTs, HRCT, autoimmune screen, liver function, and HIV testing.

Reference: eTG – 2025 – Cardiovascular; ESC/ERS – 2022 – Pulmonary Hypertension Guidelines