Snapshot A 48-year-old woman presents to the emergency department with worsening exertional dyspnea over the course of a few weeks. She reports mild chest pain when climbing the stairs or walking a few blocks. She has also noticed some swelling in both of her legs. Medical history is remarkable for sarcoidosis and she denies any alcohol, cigarette, or illicit drug use. Physical examination is notable for a loud P2 heart sound, bilateral lower extremity pitting edema, and jugular venous distension. Troponin and B-natruietic peptide are not elevated. An ECG demonstrates right axis deviation. She is admitted to the cardiac step down unit where she undergoes a right heart catheterization, which demonstrates a mean pulmonary arterial pressure of 67 mmHg at rest. Introduction Definition login to view 1 more bullet Etiology Primary pulmonary arterial hypertension login to view 5 more bullets Left heart disease (e.g., mitral stenosis, mitral regurgitation, atrial or ventricular (diastolic or systolic) dysfunction) Lung disease (e.g., chronic obstructive pulmonary disease, sleep apnea, and interstitial lung disease) Chronic thromboembolic disease (e.g., pulmonary embolism) Sarcoidosis Malignancy compressing pulmonary vessels Presentation Symptoms login to view 2 more bullets Physical examination login to view 7 more bullets Imaging Echocardiogram login to view 3 more bullets Radiography of the chest login to view 4 more bullets Studies ECG login to view 1 more bullet Right heart catheterization login to view 9 more bullets Differential Myocardial infarction login to view 2 more bullets Treatment Conservative login to view 3 more bullets Medical login to view 10 more bullets Complications Right ventricular dysfunction Right heart failure Arrhythmia Prognosis Can result in right-sided heart failure