Pulmonary Arterial Hypertension


Pulmonary hypertension is a cardiovascular disease that causes high blood pressure in the pulmonary arteries. The lung's arteries and capillaries become narrowed or blocked, the heart's right ventricle pumps harder, leading to weaken cardiac muscles.


The signs and symptoms of pulmonary arterial hypertension are:
  • Shortness of breath with exertion
  • Fatigue
  • Ankle edema
  • Chest pain
  • Syncope with exertion

Auscultation of Pulmonary Hypertension

When auscultating for possible pulmonary hypertension, these locations are important:

  • Second left intercostal space (2LICS)
  • Third left intercostal space (3LICS)
  • Left lower sternal border (LLSB)
  • Right lower sternal border (RLSB)

The right ventricular third and fourth heart sounds are only heard with inspiration and only at the RLSB.

The murmur of tricuspid regurgitation increases in intensity and is best heard at the LLSB. It can also be heart at the RLSB.

The murmur of pulmonic insufficiency (the Graham Steel murmur) increases with intensity with full expiration and is best heard at the 3LICS (Erb's Point). It can also be heard at the 2LICS.

Pulmonary Hypertension Short Course

We have teamed with PracticalClinicalSkills.com to provide several cases. This short course include a virtual patient's chart, heart sounds, lab results and diagnosis quiz.

Begin Pulmonary Hypertension Lessons