Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents for evaluation of pulmonary regurgitation. Reports symptoms of [dyspnea on exertion / fatigue / peripheral edema / palpitations]. Onset of symptoms noted [duration]. Denies syncope, chest pain, or orthopnea. History significant for [congenital heart disease / pulmonary hypertension / prior valve surgery].
Clinical Examination Findings
Cardiovascular exam: Regular rate and rhythm. Grade [1-4/6] early diastolic decrescendo murmur heard best at the left sternal border (Graham Steell murmur). S1 normal, S2 split with accentuated P2 component. No palpable thrills. JVP [elevated/normal]. Peripheral pulses 2+ and symmetric. Lower extremities: [trace/1+/2+] pitting edema noted.
Treatment Protocol
Management plan: 1. Serial echocardiography to monitor right ventricular size and function. 2. Diuretic therapy [medication/dose] for volume overload. 3. Treat underlying etiology (e.g., pulmonary hypertension management). 4. Referral to cardiothoracic surgery for consideration of pulmonary valve replacement if RV dysfunction or severe symptoms develop.