Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, fatigue, and peripheral edema. History significant for rheumatic mitral stenosis (MS) and congenital atrial septal defect (ASD). Symptoms exacerbated by physical activity; reports orthopnea and paroxysmal nocturnal dyspnea. No history of syncope or chest pain.
Clinical Examination Findings
Cardiovascular exam reveals a hyperdynamic precordium with a right ventricular heave. Auscultation demonstrates a loud S1, a mid-diastolic rumble at the apex, and a fixed split S2. Signs of right-sided heart failure present, including jugular venous distension (JVD), hepatomegaly, and pitting pedal edema.
Treatment Protocol
Management plan includes diuretics for volume overload, beta-blockers or rate-control agents for atrial fibrillation, and anticoagulation if indicated. Definitive treatment requires surgical or percutaneous closure of the ASD combined with mitral valve repair or replacement. Serial echocardiographic monitoring is mandatory.