Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, fatigue, and decreased exercise tolerance. History is significant for exposure to [insert drug/toxin, e.g., anorexigens, dasatinib, methamphetamines]. Symptoms began [duration] following initiation/exposure. Denies orthopnea, PND, or chest pain. No prior history of cardiopulmonary disease.
Clinical Examination Findings
Vitals: Tachycardia, tachypnea, peripheral oxygen saturation [value]%. Cardiac: Loud P2, right ventricular heave, holosystolic murmur at the left sternal border consistent with tricuspid regurgitation. Pulmonary: Clear to auscultation bilaterally. Extremities: Bilateral 2+ pitting edema, jugular venous distension present.
Treatment Protocol
Immediate cessation of offending agent is mandatory. Initiate supportive therapy including diuretics for volume overload, supplemental oxygen to maintain SpO2 >92%, and anticoagulation if indicated. Referral for RHC to confirm diagnosis and assess vasoreactivity. Consider PAH-specific pharmacotherapy (ERA, PDE5i, or prostacyclin analogs) based on hemodynamic profile.