Symptoms of pulmonary hypertension vary in each individual and by how advanced the condition is. In less advanced functional classes of PH, there may not be symptoms at all. As damage progresses, symptoms can become debilitating, forcing those with PH to significantly limit their activities. Symptoms of pulmonary hypertension are similar across different types of PH.

Pulmonary hypertension treatments can improve symptoms and slow the progress of the disease in many people with PH.

Common symptoms of pulmonary hypertension

People with pulmonary hypertension may not experience every symptom.

Trouble breathing

Most people with pulmonary hypertension may experience shortness of breath or trouble breathing. You may notice breathing difficulties only with exertion, or even at rest. You may feel lightheaded or dizzy, like you are going to faint. You may even faint. A dry or persistent cough may also be a symptom of pulmonary hypertension. In advanced PH, coughing may bring up blood. Some people with PH may experience respiratory infections or vocal changes.

Pain

Angina (chest pain), pressure, and discomfort are common in people with pulmonary hypertension. Pain can sometimes be felt in the right upper abdomen. Some people with PH may experience leg cramps.

Fatigue

Fatigue is a common and debilitating symptom in pulmonary hypertension. The heart is working harder than ever, but the body may not be receiving enough blood and oxygen. You may feel especially tired after exercise or exertion.

Skin symptoms

If your skin is not receiving enough blood and oxygen, it may appear pale grey or blue – especially your lips and nails. This discoloration is known as cyanosis. Some people with pulmonary hypertension develop Raynaud’s phenomenon, a condition involving the small blood vessels of the fingers that can cause them to turn red, white, blue, or a combination of these colors. Cold temperatures sometimes provoke color change in Raynaud’s phenomenon.

Swelling

If your heart is having trouble pumping blood around your body, you may notice edema (swelling) in the legs, abdomen, or around the eyes. Edema in the abdomen is also referred to as ascites. Edema may also occur in the hands, ankles, or feet.

Cognitive symptoms

Cognitive changes, often referred to collectively as “cog fog” or “brain fog,” can include problems with memory, focus, paying attention, processing information, forgetting or confusing words, learning and remembering new things, organization, and getting lost in familiar places.

Other symptoms of pulmonary hypertension

Depression, anxiety, and insomnia are common with pulmonary hypertension, as with all chronic illnesses.

People with some types of PH may experience heart palpitations or changes in the heart rate.

Complications of pulmonary hypertension

Pulmonary hypertension can cause serious complications. In people with PH, the pulmonary artery may dilate (widen) and put pressure on the coronary artery that supplies the heart muscle itself with blood. Compression of the coronary artery can result in angina (chest pain), myocardial infarction (MI or heart attack), or sudden death. Dilation of the pulmonary arteries can also cause compression of the airways, leading to coughing and wheezing that sound like asthma. Rarely, the pulmonary artery may rupture – usually a fatal complication.

Other dangerous pulmonary (lung) complications in PH can include bleeding and the formation of blood clots.

Pulmonary hypertension can cause heart failure, also known as congestive heart failure (CHF). Heart failure is not a specific heart disease, but an advanced state of heart disease when the heart can no longer supply enough blood and oxygen to keep all the tissues of the body healthy.

Approximately half of people with PH develop pericardial effusion – excess fluid in the protective sac that surrounds the heart. If too much fluid builds up, it can exert pressure on the heart that makes it difficult to beat, a life-threatening condition called cardiac tamponade.

People with PH can develop arrhythmia, or abnormal heart rhythm. Some types of arrhythmia are potentially fatal.

Some people with PH have a greater risk for developing severe pneumonia and other serious lung infections. Those who have central venous catheter lines for the infusion of medication can develop dangerous infections due to pathogens introduced via the line.

PH can cause liver damage known as cardiac cirrhosis.

Resources

External resources

• Symptoms of Pulmonary Hypertension – Pulmonary Hypertension Association
• Pulmonary Hypertension - High Blood Pressure in the Heart-to-Lung System – American Heart Association
• Pulmonary hypertension – Mayo Clinic
• The Voice of the Patient – U.S. Food and Drug Administration

Internal resources

• PH: What People Don't See (Infographic)
• Difficulty Breathing and PH
• Depression and PH
• Pain and PH
• How does cold weather affect your PH? How do you keep warm? (Q+A)
• Does anyone else get extremely short of breath and experience pain when you bend over? (Q+A)
• Does anyone have any tips for dealing with insomnia? (Q+A)

FAQ

What are the early symptoms of pulmonary hypertension?

Pulmonary hypertension does not cause any symptoms as it begins to develop. When PH progresses to the point when symptoms become noticeable, shortness of breath is commonly experienced as the first symptom. Early symptoms of PH are often missed or misinterpreted as heart disease or another pulmonary condition. Read more about functional classes that describe the severity of PH symptoms.

What symptoms result in a diagnosis of pulmonary hypertension?

The diagnosis of pulmonary hypertension is not based on symptoms, but on the results of a wide variety of tests. Read more about the how pulmonary hypertension is diagnosed.