List 4 clinical signs on cardiovascular examination which will support the diagnosis of pulmonary hypertension
° Prominent ‘a’ wave
° Parasternal lift
° Palpable P2
° Loud P2
° Features of tricuspid regurgitation
The signs of pulmonary hypertension are mainly indirect.
- The split loud P2 is the only direct sign - it is the sound of elevated PA pressur slamming the pulmonic valve shut at the end of systole.
- If the P2 is palpable, the PA pressure is truly uncontrollably high
The rest are all features of right heart failure.
- Parasternal heave is a sign of RV hypertrophy
- a prominent "a" wave is the wave of right atrial contraction, reflected from either a stenotic tricuspid valve or a stiff non-compliant right ventricle. This also suggests that the RV is hypertrophied.
- Features of tricuspid regurgitation suggest that the RV is also dilated, and possibly decompensating.
SLEEPER, JULIAN C., EDWARD S. ORGAIN, and HENRY D. MCINTOSH. "Primary Pulmonary Hypertension Review of Clinical Features and Pathologic Physiology with a Report of Pulmonary Hemodynamics Derived from Repeated Catheterization." Circulation 26.6 (1962): 1358-1369.
(this is a nice old-school article witrh a discussion of several cases of severe pulmonary hypertension, and its various clinical features)