what is the clinical features of pulmonary hypertension?

Clinical Features of Pulmonary Hypertension (PH)

Pulmonary hypertension often develops gradually, and symptoms may be non-specific in the early stages. As the disease progresses, signs and symptoms reflect right-sided heart strain and reduced oxygenation.

Symptoms (What the patient feels)

Symptom Description
Dyspnea (shortness of breath) Most common and early symptom; worsens with exertion
Fatigue Due to reduced cardiac output
Chest pain or tightness Especially during exertion (may mimic angina)
Palpitations Irregular heartbeats due to right atrial strain
Syncope or dizziness Especially on exertion; due to low blood flow to the brain
Edema Swelling in legs, ankles, feet—due to right heart failure
Abdominal bloating or fullness Due to hepatic congestion (enlarged liver)
Cough and hemoptysis (rare) May occur due to pulmonary artery rupture or infarct

Signs (What is observed during examination)

Sign Clinical Finding
Loud P2 Accentuation of the second heart sound (pulmonary component)
Right ventricular heave Palpable impulse at the left parasternal area (RV hypertrophy)
Jugular venous distension (JVD) Elevated jugular veins from right-sided heart failure
Peripheral edema Pitting edema in the lower limbs
Hepatomegaly Enlarged, tender liver due to congestion
Ascites Fluid in the abdomen (late stage)
Cyanosis Bluish discoloration from hypoxemia (advanced disease)
Tricuspid regurgitation murmur Systolic murmur over lower left sternal border

Functional Classification (WHO/NYHA)

Pulmonary hypertension is also classified by functional limitation:

Class Description
I No limitation of physical activity
II Mild limitation; comfortable at rest, symptoms on ordinary activity
III Marked limitation; comfortable at rest, symptoms on less than ordinary activity
IV Symptoms at rest; severe limitation of physical activity

Complications

  • Right heart failure (cor pulmonale)

  • Arrhythmias

  • Sudden cardiac death

  • Hemoptysis (rare but serious)

  • Pulmonary embolism (in chronic thromboembolic PH)

Quick Summary

Early Features Dyspnea, fatigue, chest discomfort
Progressive Features Syncope, peripheral edema, cyanosis
Signs of Right Heart Failure JVD, hepatomegaly, leg swelling
Auscultation Findings Loud P2, murmur of tricuspid regurgitation


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