**6. Signs and symptoms**

Early symptoms are nonspecific. The most common symptoms include dyspnea, weakness and recurrent syncope. Other symptoms include fatigue, angina, and abdominal distention. Symptoms at rest are reported only in very advanced cases.[1], [24]

The physical signs of pulmonary hypertension include left parasternal lift, loud pulmonary component of the second heart sound (P2), pansystolic murmur of tricuspid regurgitation, diastolic murmur of pulmonary insufficiency, and right ventricular S3. Jugular vein distention, hepatomegaly, peripheral edema, ascites, central cyanosis and cool extremities may be seen in patients with advanced disease. [25] The lung examination is usually normal.
