The signs and symptoms of pulmonary hypertension are variable and greatly affected by the underlying cause of the pulmonary hypertension. (See What Is Pulmonary Hypertension? ) If there is an underlying disease causing the pulmonary hypertension, the manifestations of the underlying disease may obscure the findings of pulmonary hypertension. Therefore, physicians caring for patients with diseases that can result in pulmonary hypertension must be ever vigilant in their search for any signs or symptoms of pulmonary hypertension.
The earliest manifestation of pulmonary hypertension is an insidious onset of a slowly progressive effort-related dyspnea which is rather non-specific and consistent with other diagnoses. There also may be fatigue and weakness as well as chest pain resembling angina.
As the disease progresses and the findings associated with right heart failure or cor pulmonale may supervene, a multitude of physical findings may be uncovered. At first these findings may be subtle, but awareness of their presentation allows for early detection of pulmonary hypertension.
The physical examination in patients with pulmonary hypertension the following pulmonary hypertension symptoms may be present:
The pulmonary component (P2) of the second sound (S2) becomes loud and a pulmonary flow murmur may be heard.
Hepatomegaly, abdominal distention, and peripheral edema often occur.
Jugular venous distention may be observed.
A right ventricular heave may be palpated along the left sternal border.
The systolic murmur of tricuspid regurgitation may be heard along the lower left sternal border and increase with inspiration.
A right ventricular third (S3) heart sound and a right atrial fourth (S4) heart sound may be heard.
An early diastolic murmur of pulmonary regurgitation may be heard late in the course of pulmonary hypertension.