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