Libby: Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 8th ed.
Copyright © 2007 Saunders, An Imprint of Elsevier
CLINICAL ASSESSMENT OF THE PATIENT WITH SUSPECTED PULMONARY HYPERTENSION
“Cardiovascular findings consistent with pulmonary hypertension and right ventricular pressure overload include a large a wave in the jugular venous pulse, a low-volume carotid arterial pulse with a normal upstroke, a left parasternal (right ventricular) heave, a systolic pulsation produced by a dilated, tense pulmonary artery in the second left interspace, an ejection click and flow murmur in the same area, a closely split second heart sound with a loud pulmonic component, and a fourth heart sound of right ventricular origin. Late in the course, signs of right ventricular failure (e.g., hepatomegaly, peripheral edema, and ascites) may be present.”