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What are the clinical features of pulmonary hypertension

Normal pulmonary artery pressure is 25/10mm of Hg. Pulmonary hypertension occurs when it goes beyond 30/15mm Hg.
Following are the important symptoms of pulmonary hypertension.
1.    Breathlessness , dyspnoea on exertion
2.    Easy fatiguability
3.    Dizziness
4.    Syncope or black out
5.    Chest pain
6.    Cough with hemoptysis
Physical sign in pulmonary hypertension are given below.
-          Pulse is low volume
-          JVP shows prominent a wave
Inspection finding are
Pulsations in the second intercostal area
Epigastric pulsations
Palpatory findings are
Palpable P2
Palpable epigastric pulsation
Left parasternal heave
Auscultatery  findings are
Following findings occur in sequence
1.    S1 audible
2.    Pulmonary ejection click will become audible
3.    Ejection systolic murmur may be heard
4.    Splitting of S2 become narrow
5.    P2 is loud.
6.    Graham steel murmur is an early diastolic murmur due to pulmonary incompetence.
Right sided S3 will be heard. Which is called as RV gallop.
The most commonly found findings are ejection systolic murmur and loud P2.
Causes of pulmonary hypertension
1.    Passive causes
PHTN is due to left sided heart disease
Examples are
-          Mitral stenosis
-          Mitral regurgitation
-          Aortic regurgitation
-          Aortic stenosis
2.    Hyperkinetic
1.      Atrial septal defect
2.        VSD
3.       PDA
3.    Vasoconstrictive causes are
4.    Obstructive causes
7.    Obliterative causes are SLE. PSS, PAN
8.    Neuro humeral or idiopathic cause is – Primary pulmonary hypertension.