Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA Class II/III), orthopnea, and paroxysmal nocturnal dyspnea. History significant for long-standing hypertension and diastolic dysfunction. Current symptoms include peripheral edema and exercise intolerance. No history of prior MI or reduced LVEF.
Clinical Examination Findings
Cardiovascular exam reveals regular rate and rhythm, S4 gallop present, no S3. JVD noted at 8cm H2O. Lungs: bibasilar crackles. Extremities: 2+ pitting edema to the mid-shin bilaterally. BMI elevated. BP 145/90 mmHg.
Treatment Protocol
Initiate SGLT2 inhibitor therapy (e.g., Empagliflozin). Optimize blood pressure control with ACE inhibitors or ARBs. Titrate loop diuretics (e.g., Furosemide) to achieve euvolemia. Recommend strict sodium restriction (<2g/day) and daily weight monitoring.