Pulmonary hypertension history and symptoms

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Editor(s)-in-Chief: C. Michael Gibson, M.S., M.D. [1] Phone:617-632-7753; Assistant Editor(s)-in-Chief: Lisa Prior

Overview

History

  • When approaching pulmonary hypertension, it is important to start with a detailed clinical history.
  • The presenting symptoms are important but a comprehensive past medical history, medication history, family and social history and review of systems may reveal further clues as to the etiology of the condition.

Symptoms

The average time of onset of initial symptoms in pulmonary hypertension (PH) to diagnosis is 2 years.[3] This is perhaps primarily due to non-specificity of symptoms and considerable overlap with symptoms of other pulmonary and cardiovascular diseases. It for this reason, a detailed clinical history must be obtained. Presenting symptoms suggestive of pulmonary hypertension on initial presentation are as follows in order of likelihood (National Registry):

WHO Functional Classification:

Clinically, a patient may be categorised into a particular class using the WHO modified functional classification system for pulmonary hypertension (modified from NYHA functional classification system for heart failure). The benefit of this model is that it provides a baseline for monitoring; it is a prognostic predictor and it guides therapy selection. See table below for WHO functional classification: [5]

Class WHO Functional Classification
I Patients with pulmonary hypertension but without resulting limitations of physical activity. Ordinary physical activity does not cause undue fatigue or dyspnea, chest pain, or heart syncope.
II Patients with pulmonary hypertension resulting in slight limitation of physical activity. They are comfortable at rest. Ordinary physical activity results in undue fatigue or dyspnea, chest pain, or heart syncope.
III Patients with pulmonary hypertension resulting in marked limitation of physical activity. They are comfortable at rest. Less than ordinary physical activity causes undue fatigue or dyspnea, chest pain, or heart syncope.
IV Patients with pulmonary hypertension resulting in inability to carry on any physical activity without symptoms. These patients manifest signs of right heart failure. Dyspnea and/or fatigue may be present even at rest. Discomfort is increased by physical activity.

References

  1. 1.0 1.1 1.2 1.3 Budev MM, Arroliga AC, Jennings CA (2003). "Diagnosis and evaluation of pulmonary hypertension". Cleve Clin J Med. 70 Suppl 1: S9–17. PMID 12716138. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Carolyn H. Welsh; Michael E. Hanley (2003). Current diagnosis & treatment in pulmonary medicine. New York: Lange Medical Books / McGraw-Hill. ISBN 0-07-121971-4.
  3. 3.0 3.1 Rich S, Dantzker DR, Ayres SM; et al. (1987). "Primary pulmonary hypertension. A national prospective study". Ann. Intern. Med. 107 (2): 216–23. PMID 3605900. Unknown parameter |month= ignored (help)
  4. Kawut SM, Silvestry FE, Ferrari VA; et al. (1999). "Extrinsic compression of the left main coronary artery by the pulmonary artery in patients with long-standing pulmonary hypertension". Am. J. Cardiol. 83 (6): 984–6, A10. PMID 10190427. Unknown parameter |month= ignored (help)
  5. Harrison W. Farber; Hill, Nicholas Morison (2008). Pulmonary Hypertension (Contemporary Cardiology). Totowa, NJ: Humana Press. ISBN 1-58829-661-X.

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