ÎA right ventricular S4
gallop
ÎA prominent jugular "a" wave suggesting high right-ventricular filling pressure
ÎSigns of more advanced disease: > Diastolic murmur of pulmonary regurgitation
> TR detected by elevated jugular venous pressure with accentuated V waves, hepatojugular reflux and a pulsatile liver
> Indications of right ventricular failure—right ventricular S3 gallop, marked distension of the jugular veins, pulsatile hepatomegaly, peripheral edema, and ascites
> Low BP, diminished pulse pressure, cool extremities indicate presence of markedly reduced cardiac output and peripheral vasoconstriction
Table 4. Procedures Recommended for the Diagnosis and Confirmation of PAH
In patients with clinical suspicion of, or documented PAH
ÎDoppler echocardiography should be performed > To detect PAH > To look for left ventricular systolic and diastolic dysfunction, left-sided chamber
enlargement, or valvular heart disease
ÎRight-heart catheterization is required to confirm the presence of PAH, establish specific diagnosis, and determine severity of PAH.
ÎSerial determinations of functional class and exercise capacity assessed by 6MWD provide benchmarks for disease severity, response to therapy, and progression of disease.
ÎLung biopsy is not recommended because of the risk, except under circumstances in which a specific question can be answered only by tissue examination.
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