Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea on exertion, orthopnea, and paroxysmal nocturnal dyspnea. Symptoms consistent with NYHA Class III/IV functional limitation. Significant history of hypertension and diastolic dysfunction. Current status reflects restrictive filling pattern, elevated LV filling pressures, and clinical signs of volume overload.
Clinical Examination Findings
Vitals: Tachycardic, hypertensive, tachypneic with O2 saturation <92% on room air. HEENT: JVD present at 45 degrees. CV: S4 gallop, displaced PMI, holosystolic murmur of functional MR. Lungs: Bilateral bibasilar crackles. Extremities: 3+ pitting edema to the mid-thigh, cool peripheries.
Treatment Protocol
Initiate aggressive diuresis with IV loop diuretics (e.g., Furosemide). Optimize blood pressure control with ARNI or ACEi/ARB and MRA. Consider SGLT2 inhibitors for mortality benefit. Strict sodium restriction (<2g/day) and fluid restriction (<1.5L/day). Monitor daily weights and electrolytes.