Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, orthopnea, and palpitations. History significant for endemic exposure to Trypanosoma cruzi. Reports episodes of syncope or near-syncope suggesting underlying conduction system disease or ventricular arrhythmias. Review of systems positive for nocturnal cough and peripheral edema.
Clinical Examination Findings
Cardiovascular exam reveals displaced apical impulse, S3 gallop, and holosystolic murmur consistent with functional mitral regurgitation. Jugular venous distension noted. Extremities show 2+ pitting edema. ECG demonstrates right bundle branch block (RBBB) and left anterior fascicular block (LAFB).
Treatment Protocol
Initiate guideline-directed medical therapy (GDMT) including ACE inhibitors/ARBs, beta-blockers, and mineralocorticoid receptor antagonists. Consider loop diuretics for volume overload. Evaluate for ICD/CRT implantation based on LVEF and conduction abnormalities. Anticoagulation indicated if atrial fibrillation or apical aneurysm with thrombus is present.