Pulmonary hypertension is characterized by an increase in the blood pressure in the lung. It is defined by a mean pulmonary artery pressure (PAP)≥ 25 at rest with normal PCWP. Pulmonary hypertension affects men and women of all ages. It is a serious condition that can progress without detection because clinical clues are nonspecific. Once suspected, pulmonary hypertension should be evaluated aggressively.

Clinical Clues

Suggestive Symptoms:

  • Shortness of breath on exertion.
  • Fatigue.
  • Unexplained chest pain that may worsen on exertion.
  • Syncope (fainting) or near-syncope.

Suggestive Physical Signs:

  • Increased second heart sound.
  • Left parasternal lift or heave.
  • Tricuspid murmur.
  • Signs of Right Heart Failure - venous distension, ankle swelling (abdominal distension).

Other Suggestive Findings:

  • Chest X-Ray - enlarged pulmonary arteries.
  • EKG criteria for right ventricle hypertrophy.
  • Echocardiogram - enlarged RV, septal flattening, increased pulmonary artery pressures, tricuspid regurgitation.

Risk Factors for Pulmonary Hypertension

  • Family history.
  • Collagen vascular diseases.
  • Cirrhosis of liver.
  • Blood clots in legs or lungs.
  • HIV.
  • Drugs (diet pills, cocaine, amphetamines).
  • Sleep apnea.
  • Sickle cell disease.
  • Congenital heart disease.
  • COPD, pulmonary fibrosis.
  • Sarcoidosis.

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