From the Guidelines
A late physical exam finding in a patient with pulmonary arterial hypertension is jugular vein distension, which is a sign of right heart failure and indicates advanced disease. This finding is associated with other late signs such as hepatomegaly, peripheral oedema, ascites, and cool extremities, as noted in the guidelines for the diagnosis and treatment of pulmonary hypertension 1. The physical examination may also reveal other signs of advanced disease, including a diastolic murmur of pulmonary regurgitation and a holosystolic murmur of tricuspid regurgitation, as well as a right ventricular S3 gallop, and marked distension of the jugular veins 1. Some key points to consider when examining a patient with pulmonary arterial hypertension include:
- The symptoms of PAH are non-specific and include breathlessness, fatigue, weakness, angina, syncope, and abdominal distension 1
- The physical signs of PAH include left parasternal lift, an accentuated pulmonary component of second heart sound, a pansystolic murmur of tricuspid regurgitation, a diastolic murmur of pulmonary insufficiency, and an RV third sound 1
- Lung sounds are usually normal, but the examination may also provide clues as to the cause of PH, such as telangiectasia, digital ulceration, and sclerodactyly in scleroderma, or inspiratory crackles in interstitial lung disease 1. It is essential to note that early detection of pulmonary arterial hypertension is challenging because physical exam findings are often subtle or absent until significant right ventricular dysfunction has developed, which is why echocardiography and other diagnostic tests are essential for earlier diagnosis.
From the Research
Late Physical Exam Findings in Pulmonary Arterial Hypertension
- A late physical exam finding in a patient with pulmonary arterial hypertension is often associated with advanced disease and right heart failure 2.
- Symptoms such as exercise-induced syncope, worsening symptoms at rest, and intractable right heart failure indicate critical disease 2.
- Physical exam findings may include signs of right heart failure, such as peripheral edema and marked functional limitation 2.
- Other late physical exam findings may include:
- Increased jugular venous pressure
- Hepatomegaly
- Ascites
- Peripheral cyanosis
- These findings are often associated with poor prognosis and require prompt medical attention 3.
- The diagnosis of pulmonary arterial hypertension is often challenging and requires a high index of clinical suspicion, as well as the use of various noninvasive and invasive tests 4, 5.