Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive peripheral edema, abdominal distension, and exertional dyspnea. Symptoms include early satiety, right upper quadrant discomfort due to hepatic congestion, and weight gain. Denies orthopnea or paroxysmal nocturnal dyspnea unless concomitant left-sided failure is present.
Clinical Examination Findings
Physical examination reveals elevated jugular venous pressure (JVP) with prominent v-waves, positive hepatojugular reflux, and bilateral pitting pedal edema. Cardiac auscultation demonstrates a right-sided S3 or S4 gallop and potential holosystolic murmur of tricuspid regurgitation. Abdominal exam confirms hepatomegaly and possible ascites.
Treatment Protocol
Management focuses on optimization of volume status via loop diuretics (e.g., Furosemide). Address underlying etiology (e.g., pulmonary hypertension, valvular disease). Monitor daily weights, strict sodium restriction (<2g/day), and fluid restriction if hyponatremia is present. Consider ACE inhibitors or ARBs if indicated for comorbid left heart dysfunction.