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Pulmonary Heart - Symptoms
Last reviewed: 04.07.2025
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The presence of clinical, laboratory and instrumental symptoms of chronic obstructive and other lung diseases, indicated in the article " Pulmonary heart - Causes and pathogenesis ", already allows us to assume the diagnosis of chronic pulmonary heart.
A complex of symptoms caused by respiratory failure and significantly worsened by the development of chronic pulmonary heart disease.
The most important symptom is dyspnea, which increases with physical exertion; with severe pulmonary hypertension, it can also be observed at rest. The severity of dyspnea is also significantly affected by the degree of bronchial obstruction. Characteristic features of dyspnea are the absence of orthopnea and its reduction with the use of bronchodilators and oxygen inhalations. Patients are also bothered by severe weakness, palpitations, and pain in the heart. Cardialgia is caused by hypoxia, reflex narrowing of the coronary arteries (pulmonocoronary reflex), and a decrease in the filling of the coronary arteries with an increase in the final diastolic pressure in the right ventricle. Pain in the heart is constant and decreases after oxygen inhalations.
Warm diffuse gray cyanosis caused by arterial hypoxemia is extremely characteristic. Against the background of chronic hypoxia and hypercapnia, constant headaches, daytime drowsiness, insomnia at night, sweating, and decreased appetite appear.
- Clinical signs of right ventricular hypertrophy:
- dilation of the right border of the heart (rare);
- displacement of the left border of the heart outward from the midclavicular line (due to displacement by the enlarged right ventricle);
- the presence of a cardiac impulse (pulsation) along the left border of the heart;
- pulsation and better auscultation of heart sounds in the epigastric region;
- the appearance of a systolic murmur in the region of the xiphoid process, increasing during inhalation (Rivero-Corvallo symptom) is a sign of relative insufficiency of the tricuspid valve, developing with an increase in the right ventricle.
- Clinical signs of pulmonary hypertension (high pressure in the pulmonary artery):
- an increase in the area of vascular dullness in the second intercostal space due to the expansion of the pulmonary artery;
- accentuation of the second tone and its splitting in the second intercostal space on the left;
- the appearance of a venous network in the sternum area;
- the appearance of diastolic noise in the area of the pulmonary artery due to its dilation (Graham-Still symptom).
- Clinical signs of decompensated pulmonary heart disease:
- orthopnea;
- cold acrocyanosis;
- swelling of the jugular veins that does not decrease with inhalation;
- enlarged liver;
- Plesh's symptom (pressure on an enlarged, painful liver causes swelling of the jugular veins);
- In severe heart failure, edema, ascites, and hydrothorax may develop.
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