Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive exertional dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Reports significant fatigue, peripheral edema, and abdominal distension. Denies chest pain or syncope. Symptoms consistent with diastolic heart failure and elevated systemic venous pressure.
Clinical Examination Findings
Cardiovascular: Jugular venous distension (JVD) with prominent y-descent noted. Heart sounds: S1, S2 present; S3 or S4 gallop may be audible. Apical impulse non-displaced. Pulmonary: Bilateral basal crackles. Abdominal: Hepatomegaly with positive hepatojugular reflux. Extremities: Pitting edema (1+ to 3+) noted in lower extremities.
Treatment Protocol
Management focused on symptom relief and underlying etiology. Diuretic therapy (loop diuretics) for volume overload. Beta-blockers or non-dihydropyridine calcium channel blockers to optimize diastolic filling time. Anticoagulation if atrial fibrillation is present. Consider endomyocardial biopsy or cardiac MRI for definitive diagnosis. Monitor electrolytes and renal function closely.