Post tussive suction

It is seen in patients with lung cavity after coughing. Coughing causes the cavity to collapse due to forceful expiration and during inspiration, air rushes into the cavity causing a hissing sound known as the post-tussive suction.

Source- MacLeod's clinical examination 14th edition

Conditions causing Concave st segment elevation

1. Acute Pericarditis

2. Benign early repolarization 

3. Left ventricular strain pattern in LVH

Source - ECG made easy by John Hampton 9E

Symptoms and signs of pulmonary hypertension

 Symptoms of pulmonary arterial hypertension (PAH)

•  Dyspnea on exertion (WHO - functional class)
• Fatigue and rapid exhaustion
• Dyspnea when bending forward (bendopnea)
• Palpitations
• Hemoptysis
• Exercise induced abdominal distension and nausea
• Weight gain due to fluid retention
• Syncope (during or after physical exertion)

Rare symptoms due to pulmonary artery dilation

• Exertional chest pain - dynamic compression of left main coronary artery
• Hoarseness (dysphonia) - compression of left recurrent laryngeal nerve (cardiovocal or ortner's syndrome)
• Shortness of breath, wheezing, cough, lower respiratory tract infections, atelectasis- compression of the bronchi

Signs of pulmonary hypertension 

• Central, peripheral or mixed cyanosis
• Accentuated pulmonary component of the second heart sound
• RV third heart syndrome
• Systolic murmur of tricuspid regurgitation 
• Diastolic murmur of pulmonary regurgitation 

Signs pointing towards underlying cause of PH

• Digital clubbing - cyanotic CHD, fibrotic lung disease, bronchiectasis, PVOD, or liver disease
• Differential clubbing/cyanosis - PDA/ eisenmenger's syndrome
• Auscultatory findings (crackles or wheezing or murmurs) - lung or heart disease
• Sequelae of DVT, venous insufficiency - CTEPH
• Telengiectasia - HHT or SSc
• Sclerodactyly, raynaud's phenomenon, digital clubbing, GERD - SSc

Signs of RV backward failure

• Distended and pulsating jugular veins
• Abdominal distension 
• Hepatomegaly
• Ascites
• Peripheral edema

Signs of RV forward failure

• Peripheral cyanosis(blue lips and tips)
• Dizziness
• Pallor
• Cool extremities
• Prolonged capillary refill

Ref - ERS/ESC 2022 guidelines