Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. History significant for known coronary artery disease (CAD), prior myocardial infarction, or coronary revascularization. Symptoms consistent with reduced left ventricular systolic function, NYHA functional class [I-IV]. Denies active angina, but reports chronic fatigue and decreased exercise tolerance.
Clinical Examination Findings
Cardiovascular: S1, S2 present; S3 gallop noted, consistent with volume overload. Displaced apical impulse. Jugular venous distension (JVD) present at [X] cm H2O. Lungs: Bibasilar crackles noted on auscultation. Extremities: Bilateral pitting edema [1-4+], cool peripheries. Peripheral pulses: [Symmetric/Diminished].
Treatment Protocol
Initiate/Optimize Guideline-Directed Medical Therapy (GDMT): Beta-blocker (e.g., Carvedilol/Metoprolol Succinate), ARNI or ACE inhibitor/ARB, MRA (e.g., Spironolactone), and SGLT2 inhibitor. Diuretic therapy (e.g., Furosemide) titrated to euvolemia. Consider ICD/CRT-D if LVEF ≤35% despite optimal medical therapy. Monitor electrolytes, renal function, and blood pressure.