Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea (NYHA Class [I-IV]), fatigue, and decreased exercise tolerance. Denies chest pain, syncope, or palpitations. No history of connective tissue disease, congenital heart disease, or illicit drug use. Symptoms are insidious in onset with no identifiable secondary cause.
Clinical Examination Findings
General: Patient appears in no acute distress at rest. CV: Regular rate and rhythm, prominent P2 (pulmonary component of S2), holosystolic murmur at the left sternal border (consistent with tricuspid regurgitation). Lungs: Clear to auscultation bilaterally. Extremities: Trace bilateral lower extremity edema, no cyanosis or clubbing. JVP: Elevated with prominent 'v' wave.
Treatment Protocol
Initiate PAH-specific therapy: [PDE5 inhibitor / Endothelin receptor antagonist / Prostacyclin analogue]. Monitor for side effects including headache, flushing, and peripheral edema. Schedule repeat 6-minute walk test (6MWT) and echocardiogram in 3 months. Maintain sodium restriction and avoid strenuous physical activity.