Clinical Presentation & Protocol
Patient Usually Complains Of
Patient presents with progressive symptoms of right-sided heart failure, including marked peripheral edema, abdominal distension, and exertional dyspnea. History significant for [e.g., atrial fibrillation, pulmonary hypertension, or prior valve intervention]. Symptoms are chronic and refractory to current diuretic therapy.
Clinical Examination Findings
Physical examination reveals elevated jugular venous pressure (JVP) with prominent 'v' waves. Cardiac auscultation demonstrates a holosystolic murmur at the left lower sternal border, increasing with inspiration (Carvalloโs sign). Abdominal exam significant for pulsatile hepatomegaly and ascites. Lower extremities show 3+ pitting edema.
Treatment Protocol
Management plan includes aggressive diuresis with loop diuretics and mineralocorticoid receptor antagonists. Optimization of underlying pulmonary pressures and rhythm control for atrial fibrillation. Referral for surgical or transcatheter tricuspid valve intervention (TEER/TTVR) is indicated given the severity of regurgitation and symptomatic status.