Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Reports increasing lower extremity edema, fatigue, and decreased exercise tolerance. Denies chest pain or syncope. Symptoms are consistent with worsening NYHA functional class [I/II/III/IV].
Clinical Examination Findings
Cardiovascular exam reveals displaced apical impulse, S3 gallop rhythm, and holosystolic murmur at the apex consistent with functional mitral regurgitation. Pulmonary exam demonstrates bibasilar crackles. Peripheral exam shows pitting edema (grade [1-4+]) and elevated jugular venous pressure (JVP).
Treatment Protocol
Initiate guideline-directed medical therapy (GDMT) including ACE inhibitors/ARBs/ARNIs, beta-blockers, MRA, and SGLT2 inhibitors. Adjust diuretics for volume status management. Evaluate for ICD/CRT placement based on LVEF and QRS duration. Monitor electrolytes, renal function, and blood pressure regularly.