Physical Exam for Pulmonary Hypertension:
- JVP: may be elevated with prominent A waves (from right ventricular hypertrophy). CV waves are seen in tricuspid regurgitation. A positive Kussmaul's sign and Abdominal Jugular Reflux will be seen if there is right ventricular failure.
- Inspection of the precordium: look for an apical beat. This may be displaced when left ventricular failure is the cause of pulmonary hypertension. Also look for right ventricular heaves.
- Palpation: palpate for a right ventricular heave and sub-xyphoid impulsations (from RV hypertrophy). You may also find a palpable P2. There may be a pulsatile liver edge from tricuspid regurgitation.
- Auscultation: listen for a normal S1 and loud S2. There may also be a split S2. You may hear a right sided S3 in right ventricular failure, or a right sided S4 in right ventricular hypertrophy. Finally, listen for the murmur of tricuspid regurgitation - a systolic murmur best heard at the left lower sternal border that classically gets louder with inspiration (Carvallo's sign).
- Other: patients may have peripheral edema, and rarely ascites.
Links: here is a good review article on the causes of pulmonary hypertension.
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