Which auscultatory finding best indicates pulmonary hypertension in a patient with sleep apnea?

• A. S3 At The Apex
• B. Diminished Heart Sounds
• C. Loud P2
• D. Murmur Of Aortic Stenosis

Answer: (C)

Pulmonary hypertension causes the pressure in the pulmonary arteries to rise, which makes the pulmonic valve close with greater force and for a longer duration. That accentuation of the pulmonic component of the second heart sound, P2, is what you’ll hear as a loud P2. In sleep apnea, intermittent nocturnal hypoxia leads to pulmonary vasoconstriction and vascular remodeling, driving up pulmonary pressures—so a loud P2 is the best auscultatory clue.

An S3 at the apex points to increased left-sided filling pressures or volume overload, not specifically pulmonary hypertension. Diminished heart sounds are nonspecific and can occur for many reasons. A murmur of aortic stenosis reflects a different valvular issue and doesn’t indicate elevated pulmonary pressures.