Which of the following is NOT a contraindication to exercise in pulmonary hypertension?

• A. Well-controlled symptoms.
• B. Decompensated disease.
• C. Syncope with exertion.
• D. Severe right heart failure.

Answer: (B)

In pulmonary hypertension, whether you can safely exercise depends on how stable the condition is and how well the heart is handling the workload. If symptoms are well controlled and the patient remains stable, supervised exercise can be appropriate and beneficial, helping to improve endurance, strength, and overall function. The key is careful monitoring and tailoring of intensity to avoid overexertion.

If the disease is decompensated, the right ventricle is struggling and cardiac output can’t meet the body’s demands. Pushing during exercise in this state can precipitate collapse or worsening heart failure, so it’s not advised. Likewise, exercise is unsafe if there is syncope or near-syncope with exertion, because it signals an unstable hemodynamic response and a high risk of losing consciousness during activity. Severe right heart failure likewise means very limited reserve and a high risk of decompensation with physical stress.

So, the idea is that well-controlled symptoms are not a contraindication to exercise under proper supervision, whereas decompensated disease, exertional syncope, and severe right heart failure are contraindications due to the danger they pose during physical activity.