Group 3 Pulmonary Hypertension Clinical Presentation

Updated: Oct 20, 2021
  • Author: Varun Halani, MD; Chief Editor: Zab Mosenifar, MD, FACP, FCCP  more...
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Important medical history to be mindful of in patients suspected of having pulmonary hypertension secondary to a group 3 condition include the following:

  • Chronic obstructive pulmonary disease (COPD)
  • Obstructive or restrictive lung disease
  • Interstitial lung disease (ILD)
  • Obesity
  • Daytime sleepiness
  • Snoring
  • Tonsillary hypertrophy
  • Macroglossia
  • Retrognathia/micrognathia
  • Upper airway mass lesions
  • Chest wall deformity
  • Neuromuscular disease
  • Kyphoscoliosis
  • Long-term exposure to high altitude
  • Opiate use (associated with central sleep apnea)
  • Brainstem lesion

Symptoms that may be present in patients with pulmonary hypertension due to a group 3 condition include the following:

  • Dyspnea upon exertion
  • Fatigue
  • Lethargy
  • Syncope
  • Cough
  • Hoarseness

Physical Examination

The intensity of the pulmonic component of the second heart sound (P2) may be increased, and the P2 may demonstrate fixed or paradoxic splitting. A systolic ejection murmur may be heard over the left sternal border. The murmur may be augmented by inspiration. A right ventricular heave may be palpated.

A prominent A wave may be observed in the jugular venous pulse. A right-sided fourth heart sound (S4) with a left parasternal heave may be auscultated.

Right ventricular failure leads to systemic venous hypertension and cor pulmonale. The signs of right ventricular failure include a high-pitched systolic murmur of tricuspid regurgitation, hepatomegaly, a pulsatile liver, ascites, and peripheral edema. In this scenario, a right ventricular third heart (S3) sound is also heard.

Signs of underlying cardiac, pulmonary, hepatic, or collagen-vascular disease are often present.

Patients with group 3 pulmonary hypertension often develop cor pulmonale, which further worsens hypoxemia and perpetuates pulmonary hypertension.