Following a syncopal episode, what finding is most consistent with a diagnosis of pulmonary hypertension?

In the context of pulmonary hypertension, the finding that is most consistent after a syncopal episode is the presence of a palpable P2, which refers to the second heart sound. In patients with pulmonary hypertension, the right ventricle has to work harder to pump blood through the elevated pressures in the pulmonary arteries. This increased workload can lead to a phenomenon known as right ventricular hypertrophy and can also cause an accentuated or widely split P2 due to delayed emptying of the right ventricle.

When clinicians perform a physical examination, they may palpate the P2 sound more forcefully due to the increased pressure in the pulmonary circuit. A palpable P2 indicates elevated right-sided pressures that are typical in pulmonary hypertension and is a critical finding during the examination of patients presenting with symptoms like syncope, which can occur when there is temporary insufficient blood flow to the brain due to various cardiovascular dynamics impacted by the elevated right heart pressures.

While dyspnea on exertion, clubbing of the fingers, and tricuspid insufficiency can all be associated with pulmonary hypertension, they are not as specific or significant as the palpable P2 in this scenario following a syncopal episode. Dyspnea is common but can be due to many other conditions. Club