Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, fatigue, and decreased exercise tolerance. History significant for prior venous thromboembolism (VTE). Symptoms persist despite >3 months of effective anticoagulation. Denies orthopnea or paroxysmal nocturnal dyspnea. Reports occasional exertional syncope and chest discomfort. No recent travel or surgery.
Clinical Examination Findings
Vitals: Tachycardia, tachypnea, SpO2 decreased with exertion. CV: Elevated JVP, palpable right ventricular heave, loud P2 component of S2, holosystolic murmur of tricuspid regurgitation at the left sternal border. Resp: Clear to auscultation bilaterally. Ext: Bilateral lower extremity pitting edema, no signs of acute DVT.
Treatment Protocol
Initiate lifelong anticoagulation therapy. Refer for multidisciplinary CTEPH team evaluation for consideration of Pulmonary Endarterectomy (PEA). If non-surgical, initiate targeted PAH therapy (e.g., Riociguat) and evaluate for Balloon Pulmonary Angioplasty (BPA). Monitor right heart function via serial echocardiography and 6-minute walk test.