Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive dyspnea on exertion, orthopnea, and peripheral edema. History significant for untreated obstructive sleep apnea (OSA) characterized by witnessed apneas, loud snoring, and excessive daytime somnolence. Reports increasing fatigue, nocturia, and right upper quadrant discomfort suggestive of hepatic congestion. No history of primary lung disease or left-sided heart failure.
Clinical Examination Findings
Vitals: Tachycardia, elevated JVP (distended neck veins), positive hepatojugular reflux. Cardiovascular: Loud P2 component of S2, right ventricular heave, holosystolic murmur at the left sternal border consistent with tricuspid regurgitation. Pulmonary: Clear to auscultation, no wheezing or crackles. Extremities: Bilateral pitting edema (2+ to 3+), cyanosis absent.
Treatment Protocol
Initiate aggressive CPAP therapy for OSA management. Diuretic therapy (e.g., Furosemide) for volume overload. Consider pulmonary vasodilator therapy if RV dysfunction persists. Strict adherence to weight management program, smoking cessation, and sodium-restricted diet. Regular monitoring of echocardiogram and arterial blood gases.