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Pulmonary hypertension with syncope — SCE Acute Medicine MCQ

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HardAcute Cardiac PresentationsPulmonary hypertension with syncopeSCE Acute Medicine

A 49-year-old woman is assessed on the acute medical unit. She has exertional syncope, loud P2, raised JVP and peripheral oedema. ECG shows right-axis deviation and echocardiography estimates markedly raised pulmonary pressures. Initial assessment includes relevant observations, bedside tests and urgent blood results. What is the most likely diagnosis?

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Correct answer: A — Pulmonary arterial hypertension with right heart failure

Pulmonary arterial hypertension with right heart failure is the best answer because syncope plus right heart strain and raised pulmonary pressures suggests advanced pulmonary hypertension. Non-ST-elevation myocardial infarction is plausible, but it is less appropriate for the physiology or timing described in this stem. The other distractors either fit a neighbouring presentation, delay definitive treatment, or miss the key immediate risk. Clinical pearl: Syncope in pulmonary hypertension is a high-risk feature.

Reference: ESC pulmonary hypertension guideline