Group 2 Pulmonary Hypertension Clinical Presentation

Updated: Jul 30, 2021
  • Author: Nikhil Barot, MD, MS; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Symptoms of pulmonary hypertension due to left-sided heart disease (PH-LHD) can be nonspecific and progressive. The medical history can reveal a previous diagnosis of myocardial infarction, cardiomyopathy from systolic or diastolic dysfunction, congenital cardiomyopathies or inflow or outflow tract obstruction, systemic arterial hypertension, or pericarditis.

Symptoms include the following:

  • Dyspnea
  • Weakness
  • Fatigue
  • Syncope with exertion due to poor cardiac output response to increased activity
  • Lower extremity swelling from an increase in right-sided filling pressure
  • Hoarseness (Ortner syndrome) from compression of the recurrent laryngeal nerve by an enlarged pulmonary artery
  • Right upper quadrant pain or abdominal swelling from hepatic venous congestion

Physical Examination

Examination of patients with pulmonary hypertension due to left-sided heart disease (PH-LHD) may initially reveal findings consistent with left ventricular heart failure or valvular dysfunction. As the disease progresses, patients demonstrate signs of worsening right-sided heart dysfunction.

Physical examination findings consist of the following:

  • Pulmonary crackles in the presence of volume overload
  • S3 or S4 heart sounds
  • Increased S2 heart sound intensity with development of splitting of S2 sound from right ventricular failure
  • Right ventricular heave
  • Elevated jugular venous pulse from volume overload with prominent A wave
  • Hepatomegaly with hepatic vessel pulsations from hepatic venous congestion
  • Ascites in the presence of right-sided heart failure


Group 2 pulmonary hypertension is associated with a higher morbidity and mortality when compared with patients with left-sided heart disease alone. Long-term complications include the development of right ventricular failure.

Complications of pulmonary hypertension due to left-sided heart disease (PH-LHD) include the following:

  • Right ventricular failure
  • Ascites
  • Pleural effusion
  • Peripheral extremity edema
  • Hoarseness
  • Syncope