Pulmonary hypertension is high blood pressure in the lung arteries, defined as a mean pulmonary artery pressure above 20 mmHg on right heart catheterization. It strains the right ventricle and is grouped by cause, from left heart and lung disease to chronic clots and rare pulmonary arterial hypertension.
Key symptoms
- Shortness of breath with effort
- Fatigue
- Chest pain or fainting with exertion
- Leg swelling
What you find on exam
- Loud pulmonic part of the second heart sound
- Right ventricular heave
- Raised jugular venous pressure, leg edema, enlarged liver
- Low oxygen saturation
Tests
- Echocardiogram: high estimated pulmonary pressure and right ventricle size
- Right heart catheterization to confirm
- V/Q scan to look for chronic clots
- Pulmonary function tests, sleep study, BNP, HIV and autoimmune tests
- Six-minute walk test
Treatment basics
- Treat the cause: heart failure, COPD, sleep apnea
- Oxygen if saturation is low; diuretics for fluid overload
- Chronic clot disease: lifelong anticoagulation, surgery or balloon angioplasty
- Pulmonary arterial hypertension: ambrisentan, tadalafil or prostacyclins in a specialized center
- Avoid pregnancy; vaccines and supervised exercise
Red flags
- Fainting
- Chest pain with exertion
- Worsening right heart failure: more edema, low blood pressure
Practice it in Making Synapses
Making Synapses cases
Related guides
Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations; AAMC Core Entrustable Professional Activities (Core EPAs). Written by Making Synapses. Making Synapses is not affiliated with these organizations.