Pulmonary Hypertension

Rajesh Shenoy
Symptoms, Physical Examination
PH may manifest with non-specific symptoms. In neonates and infants, frequently, the only symptom might be cyanosis perceived by the parents. In older children and adolescents, non-specific symptoms like effort intolerance, poor appetite and poor growth, nausea and vomiting may be present. In some instances, the presentation may be more ominous in the form of exertional dyspnea or syncope. In most cases, a high index of suspicion prompts diagnostic testing. Patients with pulmonary hypertension are at risk for hypertensive crises, which are exacerbated by agitation and acidosis, and may result in chest pain, syncope, or even sudden death.

Physical Examination:
In neonates and infants with a patent foramen ovale, and right-to-left shunting, systemic desaturation is present. This might also be present in older children with an atrial communication. Rarely, clubbing of the nail beds is noted. While hepatomegaly and ankle edema is present in the older population, this is not likely to be seen in infants.
The cardiac examination is remarkable for a right ventricular heave and precordial bulge on inspection, a palpable second heart sound on palpation, and a loud second heart sound which is widely split (though not fixed) on auscultation.

Pulmonary Hypertension Pulmonary Hypertension 03/18/2016
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