Complications of Pulmonary Hypertension

Right Ventricular Dysfunction Manifestations

The European Respiratory Journal reports that progressive right ventricular failure is the primary complication of pulmonary hypertension, presenting with elevated jugular venous pressure with prominent V waves, hepatomegaly and pulsatile liver, peripheral edema, ascites, cool extremities due to low cardiac output and peripheral vasoconstriction, abdominal distension from hepatic congestion, and fatigue and weakness due to decreased cardiac output 1, 2, 3, 4
Advanced right ventricular failure signs include right ventricular S3 gallop, hypotension and diminished pulse pressure, and syncope, especially with exertion 1, 2, 4

The European Respiratory Journal states that pulmonary arterial dilatation can lead to several mechanical complications, including hemoptysis due to rupture of hypertrophied bronchial arteries, hoarseness from compression of the left recurrent laryngeal nerve, wheeze caused by large airway compression, angina due to myocardial ischemia from compression of the left main coronary artery, and pulmonary artery rupture or dissection leading to cardiac tamponade, a potentially fatal complication 1, 2, 5

Supraventricular arrhythmias, such as atrial flutter and atrial fibrillation, occur in advanced disease, compromising cardiac output and leading to clinical deterioration, according to the European Respiratory Journal 1, 2
Ventricular arrhythmias are rare but may occur, as reported by the European Respiratory Journal and European Heart Journal 1, 3

The presence of digital clubbing should raise suspicion for PVOD, congenital heart disease, interstitial lung disease, or liver disease rather than idiopathic pulmonary arterial hypertension, as noted by the European Respiratory Journal 1, 2