Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Associated symptoms include bilateral lower extremity edema and recent weight gain. No reported fever, pleuritic chest pain, or hemoptysis. Symptoms are consistent with decompensated CHF resulting in secondary transudative pleural effusion.
Clinical Examination Findings
Vitals: Tachycardic, tachypneic, O2 saturation stable on room air. HEENT: JVD present. Cardiovascular: S3 gallop, displaced PMI, regular rhythm. Respiratory: Decreased breath sounds at bilateral lung bases, dullness to percussion, and reduced tactile fremitus consistent with pleural effusion. Extremities: 2+ pitting edema to the mid-shin bilaterally.
Treatment Protocol
Initiate aggressive diuresis with IV furosemide. Monitor strict intake/output and daily weights. Maintain sodium-restricted diet (<2g/day) and fluid restriction (<1.5L/day). Consider thoracentesis if effusion is symptomatic or causing significant respiratory compromise. Optimize guideline-directed medical therapy (GDMT) for heart failure.