[Differential diagnosis of pulmonary hypertension]

Symptoms of pulmonary hypertension (PH) are very nonspecific. Therefore, the mean time from symptom onset to diagnosis is about two years. Dyspnea is the most common symptom of PH. In particular, progressive dyspnea on exertion is most frequently observed as the initial symptom and seen among almost all patients at the time of diagnosis. Physical findings are often normal in early stages. The most common sign is an accentuated pulmonic component to the second heart sound. In more advanced cases, there are signs of right heart failure such as jugular venous distension, hepatomegaly and peripheral edema. Transthoracic Doppler echocardiography is the best screening test to detect PH. Right heart catheterization is required to confirm the diagnosis of PH. However, additional examinations are performed to rule out known causes of PH.