pulmonary hypertension
PHT defined as PA mean pressure ≥20 mmHg at rest (ERJ 2019;53:1801913) PA mean = CO × PVR + PA wedge pressure. Trans pulm gradient = PA mean – PA wedge.
Etiologies-pulmonary hypertension (Revised WHO Classification) (JACC 2013;62:D34)
Clinical manifestations
- Dyspnea, exertional syncope (hypoxia, ↓ CO), exertional chest pain (RV ischemia)
- Symptoms of R-sided CHF (eg, peripheral edema, RUQ fullness, abdominal distention)
- WHO class: I = asx w/ ordinary activity; II= sx w/ ord. activ; III = sx w/ min activ.; IV = sx at rest
Physical exam
- PHT: prominent P2, R-sided S4, RV heave, PA tap & flow murmur, PR (Graham Steell), TR
- ± RV failure: ↑ JVP, hepatomegaly, peripheral edema