Pulmonary Hypertension: Examination

A comprehensive clinical examination is the basis for selecting further diagnostic steps:

  • General physical examination – including blood pressure, pulse, body weight, height; further:
    • Inspection (viewing) due topossible:
      • Neck vein congestion?
        • Signs of increased right ventricular filling pressure include jugular venous congestion (JVD) or increased jugular venous pressure (JVP).
        • Elevated JVD is commonly seen in patients with decompensated heart failure.
        • Hepatojugular reflux (HJR): reliably indicates increased pulmonary capillary wedge pressure (PCWP)Positive HJR: when the jugular vein remains congested (JVP 3 cm) for the entire time during a 10-second abdominal squeeze, and JVP abruptly decreases thereafter [Positive HJR is associated with a worse prognosis].
      • Edema (praetibial edema?/water retention in the area of the lower leg/before the tibia, ankle; in supine patients: presacral/before the sacrum).
      • Central cyanosis? [bluish discoloration of skin and central mucous membranes, e.g., tongue]
      • Abdomen (abdomen)
        • Shape of the abdomen?
        • Skin color? Skin texture?
        • Efflorescences (skin changes)?
        • Pulsations? Bowel movements?
        • Visible vessels?
        • Scars? Hernias (fractures)?
    • Auscultation (listening) of the heart.
    • Auscultation of the lungs [rales (RGs)?
    • Abdominal examination [hepatomegaly (liver enlargement)? (congested liver); splenomegaly (splenomegaly)? (secondary to portal hypertension/pulmonary hypertension)]
      • Auscultation (listening) of abdomen [vascular or stenotic sounds?, bowel sounds?]
      • Percussion (tapping) of the abdomen.
        • Meteorism (flatulence): hypersonoric tapping sound.
        • Attenuation of tapping sound due to enlarged liver or spleen, tumor, urinary retention?
        • Hepatomegaly and/or splenomegaly: estimate liver and spleen size.
      • Palpation (palpation) of the abdomen (tenderness?, knocking pain?, coughing pain?, defensive tension?, hernial orifices?, renal bearing knocking pain?).
  • 6-Minute Walk Test – standardized procedure for objective assessment, determination of severity, and progression of exercise limitation attributable to cardiopulmonary causes (at baseline and during the course of the disease).
  • Health check

Square brackets [ ] indicate possible pathological (pathological) physical findings.