The diagnosis of the disorder is often delayed due to nonspecific symptoms and signs, frequently reflecting the underlying etiology. Common presenting features are exertional dyspnea, lethargy, fatigue, exertional syncope and chest pain, peripheral edema, anorexia and right upper quadrant pain [2] [3] [4]. Uncommon symptoms include cough, hemoptysis and hoarseness.

• Pain

  Common presenting features are exertional dyspnea, lethargy, fatigue, exertional syncope and chest pain, peripheral edema, anorexia and right upper quadrant pain. Uncommon symptoms include cough, hemoptysis and hoarseness. [symptoma.com]

  The patient's case is described in detail in Lancet1 He had been treated with regular transfusions since childhood for stroke, had rare episodes of vaso-occlusive pain episodes, and did not take narcotic pain medications. [ncbi.nlm.nih.gov]

  Ordinary physical activity causes undue dyspnoea or fatigue, chest pain, or near syncope. Class III : Patients with PH resulting in marked limitation of physical activity. They are comfortable at rest. [pulmonaryhypertension.ie]

  Signs and symptoms of pulmonary hypertension (PH) may include: Shortness of breath during routine activity, such as climbing two flights of stairs Tiredness Chest pain A racing heartbeat Pain on the upper right side of the abdomen Decreased appetite As [web.archive.org]

  Symptoms of PH include Shortness of breath during routine activity, such as climbing two flights of stairs Tiredness Chest pain A racing heartbeat Pain on the upper right side of the abdomen Decreased appetite As PH worsens, you may find it hard to do [nlm.nih.gov]

• Fatigue

  Dyspnoea and / or fatigue may even be present at rest. Discomfort is increased by any physical activity. [pulmonaryhypertension.ie]

  Common presenting features are exertional dyspnea, lethargy, fatigue, exertional syncope and chest pain, peripheral edema, anorexia and right upper quadrant pain. Uncommon symptoms include cough, hemoptysis and hoarseness. [symptoma.com]

  This in turn can cause symptoms such as shortness of breath, fatigue, dizziness, fainting, heart palpitations, and chest pain. Among those diagnosed with PAH, heart failure is the leading cause of death. [uabmedicine.org]

  Signs and symptoms of PH include shortness of breath, fatigue, chest pain, swelling of legs, and fainting, which could also be seen in many other diseases thus making diagnosis of PH challenging. [lluh.org]

  A 58-year-old male was admitted because of fatigue, breath shortness for 6 months, which got worse in the last 3 months. The ultrasound cardiogram (UCG) indicated a remarkably elevated pulmonary artery systolic pressure (PASP = 82 mm Hg). [ncbi.nlm.nih.gov]

• Weakness

  Also, because your heart is working harder than normal, your right ventricle becomes strained and weak. Your heart may become so weak that it can't pump enough blood to your lungs. This causes heart failure. [web.archive.org]

  The main symptoms of pulmonary hypertension are: Feeling weak and short of breath during mild activity You may have mild chest discomfort and leg swelling. [merckmanuals.com]

  Symptoms Difficulty in breathing is commonest symptom followed by weakness and fainting. Other symptoms include fatigue lethargy, loss of appetite, chest pain, cough, blood in cough, hoarseness of voice. [symptoma.com]

• Splenectomy

  We are reporting the case of a thalassaemic patient with a history of splenectomy suffering from progressive severe pulmonary hypertension related to chronic thromboembolic disease, who was successfully treated by BPA with substantial improvement. [ncbi.nlm.nih.gov]

  Older age and splenectomy were clear risk factors associated with PH. [dx.doi.org]

  […] exposure to high altitude Developmental abnormalities Chronic thromboembolic pulmonary hypertension (CTEPH) Pulmonary hypertension with unclear multifactorial mechanisms Hematologic disorders: Chronic hemolytic anemia, myeloproliferative disorders, splenectomy [symptoma.com]

  * This classification was adapted from Simonneau et al. 3 † These conditions include thyroid disorders, type 1 glycogen storage disease, Gaucher’s disease, hereditary hemorrhagic telangiectasia, hemoglobinopathies, myeloproliferative disorders, and splenectomy [pulmonaryhypertension.ie]

  These associated conditions include, but are not limited to, sarcoidosis, sickle cell anemia, chronic hemolytic anemia, splenectomy (spleen removal) and certain metabolic disorders. No matter the type, PH is a serious disease. [phassociation.org]

• Anorexia

  Common presenting features are exertional dyspnea, lethargy, fatigue, exertional syncope and chest pain, peripheral edema, anorexia and right upper quadrant pain. Uncommon symptoms include cough, hemoptysis and hoarseness. [symptoma.com]

  The most common symptoms and their frequency, reported in a national prospective study, are as follows: Dyspnea (60% of patients) Weakness (19%) Recurrent syncope (13%) Additional symptoms include fatigue, lethargy, anorexia, chest pain, and right upper [emedicine.medscape.com]

  Many of the medications are associated with side effects of anorexia or nausea, so careful attention to nutritional status is needed to maintain overall health. Infusion pump management. [ncbi.nlm.nih.gov]

• Dyspnea

  Symptoms and Signs Progressive exertional dyspnea and easy fatigability occur in almost all patients. Atypical chest discomfort and exertional light-headedness or presyncope may accompany dyspnea and indicate more severe disease. [merckmanuals.com]

  He presented with progressive severe dyspnea on exertion and lower extremity edema. [ncbi.nlm.nih.gov]

  The diagnosis of pulmonary hypertension should be suspected in patients with progressive exertional dyspnea, angina or syncope on exertion and a coexisting possible cause of the condition. [symptoma.com]

• Cough

  Other symptoms include fatigue lethargy, loss of appetite, chest pain, cough, blood in cough, hoarseness of voice. Diagnosis X ray-chest and laboratory studies are the first investigations followed by echocardiography. [symptoma.com]

  Pulmonary Hypertension Heart Breathlessness Chest pain Dizziness Fainting Loss of energy Swelling of the arms, legs, ankles or abdomen Dry cough Raynaud’s phenomenon Heart and lung disorders Family history HIV infection Connective tissue disorders Congenital [nm.org]

  The Ohio State Multidisciplinary Cough Clinic helps people with chronic coughs lasting at least six weeks. [lungcenter.osu.edu]

  He had a nonproductive cough the day before he was admitted. The day of admission he had decreased PO intake, lethargy, increased WOB. Patient had no primary care but had his 2 month vaccines from the health department. [ultrasoundoftheweek.com]

  Other symptoms, such as coughing (rarely, coughing up blood) and wheezing, are usually caused by the underlying lung disorder. [merckmanuals.com]

• Hemoptysis

  Here, we present the case of a 47-year-old man who presented with a 10-year history of progressive hemoptysis and a 2-year history of shortness of breath, in whom a diagnosis of FM was made. [ncbi.nlm.nih.gov]

  Hemoptysis has also been reported. Etiology IPAH is caused by vascular remodeling of small pulmonary arteries due to unknown causes. [orpha.net]

  Uncommon symptoms include cough, hemoptysis and hoarseness. The diagnosis of pulmonary hypertension should be suspected in patients with progressive exertional dyspnea, angina or syncope on exertion and a coexisting possible cause of the condition. [symptoma.com]

• Respiratory Distress

  This patient presented with respiratory distress and spontaneous pneumothorax at 6 months of age. [ncbi.nlm.nih.gov]

• Exertional Dyspnea

  The diagnosis of pulmonary hypertension should be suspected in patients with progressive exertional dyspnea, angina or syncope on exertion and a coexisting possible cause of the condition. [symptoma.com]

  A 58-year-old woman was referred to our hospital with a chief complaint of exertional dyspnea. [ncbi.nlm.nih.gov]

  Right ventricular failure limits cardiac output during exertion. Symptoms and Signs Progressive exertional dyspnea and easy fatigability occur in almost all patients. [merckmanuals.com]

  Right ventricular failure limits cardiac output during exertion. Symptoms and Signs of Pulmonary Hypertension Progressive exertional dyspnea and easy fatigability occur in almost all patients. [msdmanuals.com]

• Failure to Thrive

  Table 1 Risk assessment in patients with pulmonary arterial hypertension by the determinants of prognosis Lower risk Determinants of risk Higher risk No Clinical evidence of RV failure Yes No Progression of symptoms Yes No Syncope Yes Growth Failure to [jpccs.jp]

  Dyspnoea, fatigue and failure to thrive are common symptoms. Syncope is more frequent in the child, but overt RV failure is a late event and the child may die suddenly before the appearance of RV failure. [doi.org]

• Heart Failure

  It affects approximately 50% to 60% of patients with heart failure with preserved ejection fraction as well as 60% of those with heart failure with reduced ejection fraction and contributes significantly to disease progression and unfavorable outcomes [ncbi.nlm.nih.gov]

  […] to diastolic heart failure ( table 1 ) [ 4 ]. [err.ersjournals.com]

  Services Offered The Perkin Center for Heart Failure, Mechanical Circulatory Support, and Pulmonary Vascular Disease at Weill Cornell Cardiology offers: Cardiopulmonary exercise testing to identify and follow patients with pulmonary hypertension and heart [weillcornell.org]

• Chest Pain

  Ordinary physical activity causes undue dyspnoea or fatigue, chest pain, or near syncope. Class III : Patients with PH resulting in marked limitation of physical activity. They are comfortable at rest. [pulmonaryhypertension.ie]

  Common presenting features are exertional dyspnea, lethargy, fatigue, exertional syncope and chest pain, peripheral edema, anorexia and right upper quadrant pain. Uncommon symptoms include cough, hemoptysis and hoarseness. [symptoma.com]

  We describe a rare case of a right coronary artery fistula draining to the right atrium, manifesting in chest pain and pulmonary arterial hypertension (PAH). The fistula was detected on transesophageal echocardiography during the workup for PAH. [ncbi.nlm.nih.gov]

  This in turn can cause symptoms such as shortness of breath, fatigue, dizziness, fainting, heart palpitations, and chest pain. Among those diagnosed with PAH, heart failure is the leading cause of death. [uabmedicine.org]

• Tachycardia

  KEYWORDS: atrial septal defect; cardiomyopathy; hypoxia; ventricular tachycardia [ncbi.nlm.nih.gov]

  While norepinephrine is a first line agent, vasopressin is an excellent alternative or adjunct to maintain systemic vascular resistance without increasing pulmonary vascular resistance or tachycardia. [emergencymedicinecases.com]

  Serious adverse events reported with the use of inhaled iloprost include congestive heart failure, chest pain, supraventricular tachycardia, shortness of breath, peripheral edema, and kidney failure. [en.wikipedia.org]

  On examination she had a sinus tachycardia, arterial pressure was 130/80 mm Hg, the jugular venous pressure was 10 cm above the clavicle and there was a parasternal heave. [bja.oxfordjournals.org]

• Graham Steell Murmur

  Pulmonic regurgitation (Graham Steell murmur) may be apparent. A murmur of tricuspid regurgitation can be present, and a right ventricular lift (heave) may be noted. [emedicine.medscape.com]

  Steell murmur) may be apparent A murmur of tricuspid regurgitation can be present, and a right ventricular lift (heave) may be noted Jugular venous pulsations may be elevated in the presence of volume overload, right ventricular failure, or both; large [emedicine.com]

• Acrocyanosis

  Signs of right heart failure, ie, extended neck veins, edema, ascites, and acrocyanosis, occur late in the course of the disease and may signal a life-threatening situation. [doi.org]

• Arthritis

  Mortality in rheumatoid arthritis. Semin Arthritis Rheum 1995; 25:193–202. Thomas E, Symmons DPM, Brewster DH, et al. [web.archive.org]

  PAH related to exposure to toxins including diet drugs such as fenphen; street drugs including cocaine and methamphetamine; HIV; collagen vascular diseases including scleroderma, lupus and rheumatoid arthritis; chronic liver disease; and congenital heart [ucsfhealth.org]

  The role of screening with serum biomarkers and noninvasive testing remains controversial, and in this review we discuss the controversies and new recommendations in detail. a Arthritis Center b Pulmonary Center, Boston University School of Medicine, [journals.lww.com]

  KEYWORDS: Connective tissue disease; Pulmonary hypertension; Rheumatoid arthritis [ncbi.nlm.nih.gov]

• Hunger

  By JEN GUNTER Well Photo Credit Illustration by Celia Jacobs Outrunning Hunger Intense exercise may change the way certain neurons influence our appetite and metabolism. [nytimes.com]

• Dizziness

  This in turn can cause symptoms such as shortness of breath, fatigue, dizziness, fainting, heart palpitations, and chest pain. Among those diagnosed with PAH, heart failure is the leading cause of death. [uabmedicine.org]

  Fatigue, dizziness, and fainting spells also can be symptoms. Swelling in the ankles, abdomen or legs, bluish lips and skin, and chest pain may occur as strain on the heart increases. [my.clevelandclinic.org]

• Lethargy

  Common presenting features are exertional dyspnea, lethargy, fatigue, exertional syncope and chest pain, peripheral edema, anorexia and right upper quadrant pain. Uncommon symptoms include cough, hemoptysis and hoarseness. [symptoma.com]

  The day of admission he had decreased PO intake, lethargy, increased WOB. Patient had no primary care but had his 2 month vaccines from the health department. He was found to have profound respiratory acidosis and hypoxemia. Post navigation [ultrasoundoftheweek.com]

  Symptoms Mild pulmonary hypertension usually causes no symptoms, but as the pressures in the pulmonary artery increase, shortness of breath, weakness, lethargy, and fatigue become common. [verywellhealth.com]

  Other less common symptoms may include: cough, fatigue, lethargy, and dizziness. [emedicinehealth.com]

  The most common symptoms and their frequency, reported in a national prospective study, are as follows: Dyspnea (60% of patients) Weakness (19%) Recurrent syncope (13%) Additional symptoms include fatigue, lethargy, anorexia, chest pain, and right upper [emedicine.medscape.com]

The diagnosis of pulmonary hypertension should be suspected in patients with progressive exertional dyspnea, angina or syncope on exertion and a coexisting possible cause of the condition. Electrocardiography (ECG), laboratory studies (complete blood count (CBC), liver function tests, HIV serology, prothrombin time (PT), and activated partial thromboplastin time (aPTT)), arterial blood gas measurements and X-rays of the chest should be obtained. Echocardiography with Doppler flow studies is the most useful noninvasive method and can be employed to estimate the pulmonary artery pressure and ventricular function [5] [6]. Depending on the etiology, further evaluation may include pulmonary function testing, high-resolution computed tomography of the chest, polysomnography, ventilation-perfusion lung scanning and right cardiac catheterization. The diagnosis of most forms of pulmonary hypertension requires right heart catheterization and is confirmed when the mean pulmonary artery pressure is greater than 25 mmHg at rest [1].

• Pulmonary Arterial Pressure Increased

  Practice Essentials Idiopathic pulmonary arterial hypertension (IPAH) is a rare disease characterized by elevated pulmonary artery pressure with no apparent cause. [emedicine.medscape.com]

• Right Axis Deviation

  Surface electrocardiogram showed right atrial and ventricular overload with right axis deviation. Chest imaging noted enlarged central pulmonary vascularity with bilateral plethoric lung fields. [ncbi.nlm.nih.gov]

  INVESTIGATIONS The ECG may show right axis deviation and incomplete RBBB. A normal ECG, however, does not exclude pulmonary hypertension. The chest X-ray may show dilated pulmonary arteries (Figure 1) and an enlarged right ventricle. [bjgp.org]

  In pulmonary hypertension, the electrocardiogram (ECG) may demonstrate signs of right ventricular hypertrophy, such as tall right precordial R waves, right axis deviation and right ventricular strain ( Figure 1 ). [aafp.org]

  Common ECG findings include right axis deviation, R > S in V1, S1Q3T3 (suggesting right ventricular hypertrophy), and peaked P waves (suggesting right atrial dilation). [merckmanuals.com]

  These signs include the following: Right-axis deviation R/S ratio greater than 1 in lead V1 Right atrial enlargement as indicated by an increased P-wave amplitude in lead II Right bundle branch block PPH is diagnosed if no underlying etiology is found [emedicine.com]

• Incomplete Right Bundle Branch Block

  Right axis deviation (short arrow), increased P-wave amplitude in lead II (black arrowhead), and incomplete right bundle branch block (white arrowhead) are highly specific but lack sensitivity for the detection of right ventricular hypertrophy. 12 View [aafp.org]

• P Pulmonale

  […] respiratory disease) Examination prominent ‘a’ wave palpable P2 right heart failure – increased JVP, (large V waves), parasternal heave, TR murmur, hepatomegaly, peripherial oedema other signs of CHF hypoxaemia INVESTIGATIONS Bedside ECG – RVH, RAD, p-pulmonale [lifeinthefastlane.com]

• Prominent A-Wave

  ‘a’ wave palpable P2 right heart failure – increased JVP, (large V waves), parasternal heave, TR murmur, hepatomegaly, peripherial oedema other signs of CHF hypoxaemia INVESTIGATIONS Bedside ECG – RVH, RAD, p-pulmonale, tall R waves in V1, right ventricular [lifeinthefastlane.com]

  A prominent A wave may be observed in the jugular venous pulse. A right-sided fourth heart sound (S 4 ) with a left parasternal heave may be auscultated. Right ventricular failure leads to systemic venous hypertension and cor pulmonale. [emedicine.medscape.com]

  The jugular venous pulse tracing demonstrates a prominent a wave without a c or v wave being observed. The phonocardiograms (fourth left interspace and cardiac apex) show a murmur of tricuspid insufficiency and ventricular and atrial gallops. [en.wikipedia.org]

UC San Diego Health is a leader in the diagnosis and treatment of pulmonary arterial hypertension (PAH). [health.ucsd.edu]

Galiè N, Humbert M, Vachiery JL, et al : 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and [merckmanuals.com]

Several treatments are used to manage primary pulmonary hypertension, although they don't cure the condition. [ucsfhealth.org]

Pulmonary Hypertension Treatment In general, the treatment of pulmonary hypertension focuses on treating the underlying cause and managing the symptoms. [emedicinehealth.com]

PAH associated with systemic sclerosis carries a worse prognosis than idiopathic PAH. However, PAH associated with congenital heart disease has a better prognosis than idiopathic PAH. [patient.info]

If left untreated, the prognosis is poor and the disease is often fatal within a few years, emphasizing the need for a quick and accurate diagnosis. [pulmonaryhypertensionnews.com]

The diagnosis of the disorder is often delayed due to nonspecific symptoms and signs, frequently reflecting the underlying etiology. [symptoma.com]

It has a very low prevalence and its etiology is heterogeneous. Complex congenital cardiac malformations are also rare. [ncbi.nlm.nih.gov]

Clinical description Clinical manifestations of IPAH are similar to other forms of PAH regardless of its etiology. IPAH develop in adults and in rare cases in children; women are twice as likely as men to be affected. [orpha.net]

Epidemiology and genetics of pulmonary hypertension 4.1 Epidemiology and risk factors 4.2 Genetics 5. [escardio.org]

This review gives an overview of the pathophysiology and epidemiology of PH associated with left heart disease, and discusses the challenges associated with its management and treatment. [ncbi.nlm.nih.gov]

Abstract Purpose of review The review provides an update of the epidemiology, pathogenesis, risk factors, screening and treatment of pulmonary arterial hypertension in systemic sclerosis. [doi.org]

While the pathophysiology underlying the development of pulmonary hypertension (PH) in patients with HHT is not fully understood, it is believed to occur by one of two mechanisms: increases in pulmonary vascular resistance or cardiac output. [ncbi.nlm.nih.gov]

While not all pulmonary hypertension can be prevented, you can take steps to prevent it by making healthy lifestyle changes and managing high blood pressure, coronary heart disease, chronic liver disease, and chronic lung disease from tobacco use. [cdc.gov]

As a result of these blockages and constrictions, pressure builds up in the arteries and prevents the flow of blood between the lungs and heart. [uabmedicine.org]

Abstract Sleep-disordered breathing (SDB) is a risk factor for cardiovascular disease including acute coronary syndrome and acute myocardial infarction, and treating SDB prevents their development and recurrence and improves a patient's prognosis. [ncbi.nlm.nih.gov]

Pulmonary Hypertension Prevention Prevention of pulmonary hypertension may focus on reducing risk factors that may lead to the underlying cause. This is not always possible, especially in situations where the risk factors are not controllable. [emedicinehealth.com]

Pulmonary hypertension is characterized by a mean pulmonary arterial pressure exceeding 25 mm Hg at rest or 30 mm Hg during exercise [1]. The World Health Organization (WHO) classified pulmonary hypertension into five main groups based upon etiology and disease mechanisms:

Pulmonary arterial hypertension (PAH)

• Idiopathic PAH
• Heritable (BMPR2/ALK1, endoglin, SMAD9, CAV1, KCNK3/Unknown)
• Drug- and toxin-induced
• Associated with Connective tissue diseases/HIV infection/Portal hypertension/Congenital heart diseases/Schistosomiasis
• Pulmonary veno-occlusive disease (PVOD) and/or pulmonary capillary hemangiomatosis (PCH)
• Persistent pulmonary hypertension of the newborn (PPHN)

Pulmonary hypertension owing to left heart disease

• Left ventricular systolic dysfunction
• Left ventricular diastolic dysfunction
• Valvular heart disease
• Congenital/acquired left heart inflow/outflow tract obstruction and congenital cardiomyopathies

Pulmonary hypertension owing to lung diseases and/or hypoxia

• Chronic obstructive pulmonary disease
• Interstitial lung disease
• Other pulmonary diseases with mixed restrictive and obstructive pattern
• Sleep-disordered breathing
• Alveolar hypoventilation disorders
• Chronic exposure to high altitude
• Developmental abnormalities

Chronic thromboembolic pulmonary hypertension (CTEPH)

Pulmonary hypertension with unclear multifactorial mechanisms

• Hematologic disorders: Chronic hemolytic anemia, myeloproliferative disorders, splenectomy
• Systemic disorders: Sarcoidosis, pulmonary Langerhans cell histiocytosis: lymphangioleiomyomatosis, neurofibromatosis, vasculitis
• Metabolic disorders: Glycogen storage disease, Gaucher disease, thyroid disorders
• Others: Tumoral obstruction, fibrosing mediastinitis, chronic renal failure, segmental pulmonary hypertension

Definition

Pulmonary hypertension is a rise of blood pressure and resistance in the lung vessels.

Cause

Pulmonary hypertension may be without any cause or with some associated factors like cirrhosis of the liver, appetite suppressants, HIV infection, alpha adrenergic stimulants like amphetamine and cocaine. It may also be due to some underlying diseases like left side heart diseases such as valvular abnormalities, myocardial diseases, and compression of pulmonary vein or respiratory conditions including COPD, interstitial diseases, sleep apnea and high altitude sickness for a long time. It may occur after thromboembolism episode or recurrent thromboembolism.

Symptoms

Difficulty in breathing is commonest symptom followed by weakness and fainting. Other symptoms include fatigue lethargy, loss of appetite, chest pain, cough, blood in cough, hoarseness of voice.

Diagnosis

X ray-chest and laboratory studies are the first investigations followed by echocardiography. Further investigations depend on the underlying cause. To confirm the diagnosis, right-sided cardiac catheterization may be done.

Treatment

Cases are treated with oxygen, pharmacological therapy and if required surgical intervention. In secondary cases management of primary condition is important. Pharmacological agents include calcium channel blockers, endothelin-receptor antagonists, Phosphodiesterase type 5 inhibitors, soluble guanylate cyclase (sGC) stimulators, prostacyclins, digoxin, and anticoagulants.

1. Simonneau G, GalièN, Rubin LJ, et al. Clinical classification of pulmonary hypertension. J Am Coll Cardiol. 2004;43(12 Suppl S):5S.
2. Runo JR, Loyd JE. Primary pulmonary hypertension. Lancet 2003; 361:1533.
3. Peacock AJ. Primary pulmonary hypertension. Thorax 1999; 54:1107.
4. Galiè N, Humbert M, Vachiery JL, et al. 2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension: The Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS): Endorsed by: Association for European Paediatric and Congenital Cardiology (AEPC), International Society for Heart and Lung Transplantation (ISHLT). Eur Heart J. 2016 Jan 1;37(1):67-119.
5. Jacobs W, Konings TC, Heymans MW, et al. Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension. Eur Respir J 2015; 46:422.
6. Berger M, Haimowitz A, Van Tosh A, et al. Quantitative assessment of pulmonary hypertension in patients with tricuspid regurgitation using continuous wave Doppler ultrasound. J Am Coll Cardiol 1985; 6:359.