Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with persistent exertional dyspnea, reduced exercise tolerance, and fatigue following a history of prior venous thromboembolism (VTE). Symptoms are progressive, associated with NYHA functional class [I/II/III/IV]. No evidence of acute decompensation, syncope, or hemoptysis. Current anticoagulation status: [On/Off].
Clinical Examination Findings
Vitals: Stable. Cardiovascular: Loud P2, right ventricular heave, tricuspid regurgitation murmur, elevated JVP. Respiratory: Clear to auscultation bilaterally, no wheezing or crackles. Extremities: No peripheral edema or signs of active DVT.
Treatment Protocol
Initiate/Continue long-term anticoagulation therapy. Referral for V/Q scan and CT pulmonary angiography to assess for CTEPH. Evaluate for pulmonary endarterectomy (PEA) or balloon pulmonary angioplasty (BPA) candidacy. Monitor right heart function via echocardiography.