Raised pulmonary vascular resistance

Symptoms include:

• fatigue - due to low cardiac output
• hepatic pain
• ascites
• ankle swelling

Signs include:

• loss of weight and cachexia
  
  
• malar flush of mitral facies
  
  
• pulse:
  • very small, low cardiac output
  • often, atrial fibrillation
    
    
• jugular venous pressure - may be raised
  
  
• cardiac impulses:
  • right ventricular hypertrophy
  • palpable P2 - due to pulmonary hypertension
    
    
• auscultation:
• soft opening snap is often audible. Other mitral murmurs are often difficult to hear because of low flow
• loud P2
• tricuspid pansystolic murmur due to tricuspid incompetence
  
  
• liver may be enlarged and pulsatile
  
  
• shifting dullness of ascites
  
  
• dependent oedema due to right ventricular failure