II. Pathophysiology
- Increased right ventricular pressures from primary lung disease
- Results in Right Ventricular Enlargement and Right Ventricular Hypertrophy
- Eventually leads to Right Ventricular Failure
III. Causes
- See Respiratory Causes of Pulmonary Hypertension
IV. Symptoms
- Retrosternal Chest Pain
- Cough
- Dyspnea
- Fatigue
- Sputum production
V. Signs
- Tachycardia
- Cyanosis
- Finger Clubbing
- Accentuated right ventricle precordial thrust
- Along left sternal border
- Accentuated and Split pulmonic heart sound (P2)
- Right sided S4 Heart Sound
- Right Sided Heart Failure signs
- Kussmaul's Sign
- Distention of jugular neck veins on inspiration
- Pulsus Paradoxus
- Exaggerated fall in Blood Pressure on inspiration
- Jugular Vein Distention
- Hepatomegaly with Ascites
- Pedal edema
- Kussmaul's Sign
VI. Differential Diagnosis (Non-pulmonary disease)
- Mitral Stenosis
- Left to right cardiac shunts
VII. Labs
VIII. Radiology
-
Chest XRay
- Enlarged pulmonary artery
- Dilated right ventricle
-
Primary Pulmonary Hypertension signs
- Tapering of pulmonary artery branches
- Echocardiogram
-
VQ Scan (Radionuclide Lung Scan)
- Evaluate suspected recurrent Pulmonary Embolism
IX. Management
- Pulmonary therapies
- Bronchodilators
- Oxygen
- Antibiotics when indicated
-
Right Ventricular Failure
- Low Sodium Diet
- Diuretics
- Digoxin (Use with caution)
- Chronic Anticoagulation on Coumadin
- Arrhythmias: Treat Supraventricular Tachyarrhythmias