Pulmonary hypertension can cause shortness of breath, tiredness, chest pain, dizziness, a racing heartbeat, and swelling in the legs or abdomen. Symptoms often begin during physical activity and may become more noticeable over time. Some people have few symptoms in the early stages. Recognizing persistent or worsening changes and seeking medical assessment can help identify the cause and guide appropriate care.
What are the most common symptoms of pulmonary hypertension?
Pulmonary hypertension (PH) is high blood pressure in the blood vessels that carry blood from the heart to the lungs. It can make the right side of the heart work harder to pump blood. The resulting symptoms may develop gradually, making early changes difficult to recognize.
According to Mayo Clinic, common symptoms include breathlessness, chest discomfort, dizziness, fatigue, a fast or pounding heartbeat, and swelling. These experiences can also occur with other heart, lung, or general health conditions.
- Shortness of breath: Feeling breathless during activities such as walking uphill, climbing stairs, or exercising. As symptoms progress, breathlessness may occur during lighter activities or at rest.
- Fatigue and weakness: Feeling unusually tired, having less energy, or finding everyday activities more difficult than before.
- Chest pain or pressure: Discomfort in the chest that may occur during activity or at other times.
- Dizziness or lightheadedness: Feeling faint, particularly during physical exertion. Some people experience fainting.
- Heart palpitations: Noticing a racing, pounding, or unusually fast heartbeat.
- Swelling in the legs, ankles, feet, or abdomen: Fluid buildup can cause visible swelling, tight-fitting shoes, or an increase in abdominal size.
- Bluish or gray discoloration: The lips or skin may appear blue or gray when oxygen levels are low, although this sign does not occur in everyone.
How do symptoms change as pulmonary hypertension progresses?
In some people, symptoms develop slowly over months or years. Early on, breathlessness or fatigue may be noticeable only during exercise. Someone might find it harder to keep up with their usual walking pace or need more breaks when doing routine tasks.
As the condition progresses, symptoms may interfere with ordinary activities, such as getting dressed, preparing meals, or walking short distances. Breathlessness can eventually occur at rest. Swelling and other symptoms may also become more noticeable. However, symptoms do not follow the same pattern in everyone, and their intensity alone cannot establish how advanced the condition is.
The National Heart, Lung, and Blood Institute (NHLBI) notes that symptoms can be difficult to recognize because they overlap with those of other medical conditions. A gradual decline in exercise tolerance can therefore be an important change to discuss with a healthcare professional, even when there is no dramatic or sudden symptom.
Can pulmonary hypertension cause symptoms at rest?
Yes. Although breathlessness may first appear during physical activity, some people develop symptoms while sitting or lying down as the condition progresses. Persistent tiredness, chest discomfort, palpitations, or swelling may also affect daily life. Symptoms at rest are particularly important to report promptly, especially if they are new or worsening.
Sudden or severe symptoms require a different response from gradual changes. New chest pain accompanied by breathlessness, fainting, or severe difficulty breathing can signal a medical emergency, including a serious heart problem or a blood clot in the lungs.
Which symptoms need urgent medical attention?
Do not wait for a routine appointment if symptoms suggest a possible emergency. Seek emergency medical care if you experience:
- Sudden, severe, or persistent chest pain, particularly with shortness of breath.
- Severe difficulty breathing or breathlessness that starts suddenly.
- Fainting accompanied by chest pain, breathing difficulty, or a rapid heartbeat.
- New chest pain with a racing heartbeat or a feeling that you may pass out.
- Coughing up blood, especially when accompanied by sudden breathlessness or chest pain.
Call your local emergency number if these symptoms occur. In India, call 112 for emergency assistance. Do not drive yourself if you are severely breathless, faint, or experiencing significant chest pain.
The NHS advises emergency assessment for chest pain that does not settle after a few minutes, or palpitations accompanied by chest pain, breathlessness, or feeling faint. Even if symptoms improve, urgent assessment may still be necessary because serious heart and lung conditions can cause symptoms that come and go.
When should you arrange a medical appointment?
Arrange a medical assessment if you have unexplained breathlessness during ordinary activities, persistent fatigue, recurring dizziness, chest discomfort, palpitations, or swelling in your legs or abdomen. An appointment is also appropriate if you notice that activities you previously managed comfortably now leave you unusually tired or short of breath.
Describe when the symptoms began, whether they occur during activity or at rest, how often they happen, and whether they are becoming more frequent. Mention any known heart or lung conditions and medicines you take. This information can help your clinician decide which examinations or tests are appropriate.
How are pulmonary hypertension symptoms assessed?
Symptoms alone cannot confirm pulmonary hypertension. A healthcare professional considers your medical history, the pattern of symptoms, a physical examination, and the results of appropriate tests. Breathlessness, for example, may also be related to asthma, other lung conditions, anemia, or heart disease.
As described by Mayo Clinic's pulmonary hypertension diagnosis guide, an assessment may include blood tests, an electrocardiogram (ECG), a chest X-ray, or an echocardiogram, which uses sound waves to create pictures of the heart. Additional investigations may be needed to clarify the cause. Right heart catheterization can measure pressure inside the heart and pulmonary arteries and is used to confirm the diagnosis when indicated.
Keep track of meaningful changes in your symptoms and discuss them during your appointment. Do not assume that breathlessness is simply due to aging, being out of shape, or a pre-existing condition if it is new, persistent, or getting worse.