Pulmonary Hypertension

Pulmonary hypertension is suggested by her exertional symptoms of fatigue, dyspnea, syncope and angina, particularly in the presence of peripheral edema.

In patients with severe pulmonary hypertension, syncope may occur when activity causes a further increase in right ventricular systolic pressure, stimulating intramyocardial receptors that lead to peripheral arteriolar and venous vasodilation. The resultant drop in cardiac filling and blood pressure leads to decreased cerebral blood flow and unconsciousness.

Patients with pulmonary hypertension often present with angina that is similar in character to that in patients with coronary artery disease. It is produced during stress by the pressure loaded hypertrophic right ventricle that increases myocardial oxygen demand and decreases coronary blood flow.

Pulmonary hypertension has many causes, but most commonly results from left heart failure. It may also be secondary to congenital heart disease, acquired valvular disease, and pulmonary parenchymal or vascular disease.

It is important to note that our patient’s history suggests an acquired etiology. Careful cardiac examination will help to determine the cause of our patient’s pulmonary hypertension.