Pulmonary Hypertension Symptoms

Perhaps the most troubling characteristic of pulmonary hypertension is the inability to directly connect symptoms with the disease. Many of the symptoms of pulmonary hypertension, such as shortness of breath, are seen in other lung diseases and heart disease. Pulmonary hypertension may even occur without medical symptoms making it difficult to diagnose. As the disease progresses, symptoms begin to resemble those associated with congestive heart failure.

Since PH is a rare disorder most doctors try to exclude other diseases before making a medical diagnosis of PH.

Dyspnea and Syncope

Dyspnea, or difficulty breathing, is one of the most common symptoms of pulmonary hypertension. Dyspnea is due to a lack of oxygen in the blood either because enough oxygen is not present or because of inadequate gas exchange. Dyspnea can be caused by exertion but can also be present with light activity. Dyspnea can be connected to other diseases including emphysema, asthma, heart disease, or metabolic diseases.

Syncope, or dizziness, is also a common symptom of pulmonary hypertension. If oxygen is unable to reach the brain, a faint feeling or syncope can occur. Syncope can lead to fainting spells. When a person faints they have a moment of loss of consciousness. This is one of the most common symptoms of pulmonary hypertension that brings people to the doctor.


Cyanosis is the medical term for a bluish cast to the skin and mucous membranes, especially the lips, cuticles, edge of the ears, and tip of the nose. While temporary cyanosis may occur due to cold temperatures, cyanosis due to lung or heart disease is an indication of low oxygen levels. By the time cyanosis appears, other symptoms of pulmonary hypertension might also be present. Syncope may accompany cyanosis caused by disease.


Fatigue is a common symptom of many diseases including the common cold. Most of us have at one time or another felt fatigue but not all of us have had extreme fatigue, the type of fatigue often seen in pulmonary hypertension. Extreme fatigue is a medical symptom that can indicate the onset of heart failure. Extreme fatigue is the response to try to keep up with the body’s demand for oxygen. If the heart cannot keep up with the body’s demand for oxygen, the muscles lose oxygen and become fatigued.

Shortness of Breath

Breathlessness and shortness of breath are more advanced symptoms of pulmonary hypertension. As the heart becomes weaker its contractions are not strong enough to pump blood to the rest of the body. Sometimes, blood is left in the heart and backs up into the lungs. In order to meet the oxygen demand the lungs breathe more rapidly. Shortness of breath may be present only with exertion, or in severe cases even at rest.

Peripheral Edema

With inadequate circulation of blood peripheral edema, or fluid build-up, in other areas of the body can develop. The most common area of edema is the ankle. Edema in the ankles may be an indication that edema is also present in other parts of the body.

Symptoms of Pulmonary Hypertension and Cor Pulmonale

When the pulmonary arteries have been compromised, increasing pressure is needed to get blood to the lungs. Normal pulmonary artery pressure is 14 mmHg (millimeters quicksilver). In PH, pressures can exceed 25 mmHg.

To compensate for the increased pumping pressure, the heart muscle changes in size. An enlarged heart is a sign that the heart is working very hard to circulate blood and oxygen to the body. The right side of the heart, which is not accustomed to high blood pressure, may also weaken. Right-sided heart failure that occurs as a result of pulmonary hypertension is known as cor pulmonale.


American Lung Association. (November 2003). Primary pulmonary hypertension (PPH) fact sheet.

Beers, M. H.