Clinical Presentation & Protocol
Patient Usually Complains Of
Patient is a known HIV-positive individual presenting with progressive exertional dyspnea (NYHA Class [I-IV]), fatigue, and decreased exercise tolerance. Denies orthopnea or paroxysmal nocturnal dyspnea. No history of illicit stimulant use. Current ART regimen: [Insert Regimen]. Symptoms are consistent with suspected HIV-associated pulmonary arterial hypertension.
Clinical Examination Findings
Cardiovascular exam reveals a loud P2, a right-sided S4 gallop, and a holosystolic murmur at the left sternal border consistent with tricuspid regurgitation. Jugular venous distension (JVD) noted. Lower extremities show [0/1+/2+] pitting edema. Lungs are clear to auscultation bilaterally. No evidence of hepatomegaly or ascites.
Treatment Protocol
Initiate optimization of ART therapy. Start PAH-specific targeted therapy: [PDE5 inhibitor / Endothelin receptor antagonist / Prostacyclin analogue]. Monitor for drug-drug interactions between ART and PAH medications. Schedule repeat TTE and 6-minute walk test (6MWT) in [X] weeks. Refer to pulmonary hypertension center for right heart catheterization.