Signs

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
  • an RV third sound

 

Jugular vein distension, hepatomegaly, peripheral oedema, ascites and cool extremities characterise patients in more advanced state. Lung sounds are usually normal.


The examination may also provide clues as to the cause of PH

 

   
 
  • telangiectasia, digital ulceration and sclerodactyly are seen in scleroderma
  • inspiratory crackles may point interstitial lung disease
  • the stigmata of liver disease such as spider naevi, testicular atrophy and palmar erythema should be considered
  • if digital clubbing is encountered in "IPAH", an alternative diagnosis such as CHD or PVOD should be sought.

 

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5th International Congress of the Swiss Society of Pulmonary Hypertension (SSPH)
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