17th January 2024

Presentation

Symptoms

Symptoms of pulmonary hypertension can be non-specific and most commonly include fatigue, shortness of breath, angina and syncope. These symptoms are all classically worse on exertion, and severity of symptom burden is often assessed for these patients by calculating their MRC Dyspnoea Scale score (grading breathlessness on a scale of 0-4). Structural complications of the disease can also result in further symptoms such as haemoptysis (due to bronchial artery rupture) and hoarseness of voice (due to compression of the left recurrent laryngeal nerve).

Clinical signs

• Right ventricular heave
• Central cyanosis
• Peripheral oedema
• Ascites
• Loud P2
• Pansystolic murmur heard loudest at the left lower sternal edge (secondary to tricuspid regurgitation)
• Elevated jugular venous pressure
• Lancisi’s sign (giant C-V waves seen in tricuspid regurgitation)

Take care to also observe for clinical signs on examination that may point you towards the underlying diagnostic cause of the pulmonary hypertension, such as digital clubbing or telangiectasia (3).