Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, fatigue, and signs of underlying portal hypertension. History significant for chronic liver disease/cirrhosis. Denies syncope or chest pain. Reports abdominal distension, early satiety, and occasional peripheral edema. Functional class: [NYHA I/II/III/IV].
Clinical Examination Findings
Vitals: Stable/Tachycardic. CV: Loud P2, right ventricular heave, tricuspid regurgitation murmur at left sternal border. Abdomen: Distended, positive fluid wave/shifting dullness (ascites), hepatosplenomegaly. Extremities: 2+ pitting edema, spider angiomata, palmar erythema. JVP: Elevated with prominent v-waves.
Treatment Protocol
Initiate PAH-specific therapy (e.g., PDE5 inhibitors, ERAs) with caution due to hepatic metabolism. Optimize management of portal hypertension (beta-blockers, diuretics, paracentesis). Monitor LFTs, MELD score, and right heart catheterization parameters. Referral to transplant hepatology and pulmonary hypertension specialist.