Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA Class [I-IV]), fatigue, and decreased exercise tolerance. Denies orthopnea, PND, or peripheral edema. No history of connective tissue disease, congenital heart disease, portal hypertension, or anorexigen use. Symptoms are insidious in onset.
Clinical Examination Findings
Cardiovascular exam reveals a loud pulmonic component of S2 (P2), a right-sided S4, and a holosystolic murmur at the left sternal border consistent with tricuspid regurgitation. Jugular venous distention (JVD) present with prominent 'a' and 'v' waves. Lower extremities show trace to 2+ pitting edema. Lungs are clear to auscultation bilaterally.
Treatment Protocol
Initiate PAH-specific therapy: [PDE5 inhibitor / Endothelin receptor antagonist / Prostacyclin analog]. Monitor for systemic hypotension, peripheral edema, and flushing. Schedule repeat 6-minute walk test (6MWT), NT-proBNP levels, and transthoracic echocardiogram in 3 months to assess treatment response and functional status.