Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for follow-up of CTD-associated pulmonary arterial hypertension. Reports progressive dyspnea on exertion (NYHA Class [I-IV]), fatigue, and occasional lightheadedness. Denies syncope, chest pain, or palpitations. Stable adherence to PAH-specific pharmacotherapy. No recent exacerbations of underlying connective tissue disease symptoms (e.g., joint pain, skin tightening, Raynaud’s).
Clinical Examination Findings
Vitals: Stable, O2 saturation [X]% on room air. Cardiovascular: Regular rate and rhythm, accentuated P2, holosystolic murmur at the left sternal border consistent with tricuspid regurgitation, no S3/S4. Respiratory: Clear to auscultation bilaterally, no wheezing or crackles. Extremities: Trace to 2+ pitting edema, no cyanosis or clubbing. Skin: Evidence of underlying CTD (e.g., sclerodactyly, telangiectasia, or malar rash).
Treatment Protocol
Continue current PAH-targeted therapy: [Drug Name/Dose]. Monitor for side effects including peripheral edema, headache, or flushing. Maintain strict adherence to immunosuppressive regimen for underlying CTD. Schedule repeat 6-minute walk test (6MWT), NT-proBNP, and echocardiogram in [X] weeks. Advise avoidance of strenuous physical activity and pregnancy.