How to Answer General Appears Fatigued Questions (Complete Guide)
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Original Question
General: Appears fatigued but not in acute distress. Vitals: BP 132/78 mmHg, HR 98 bpm, RR 20, SpOâ‚‚ 94% on room air. Neck: Elevated jugular venous pressure. Cardiovascular: Loud and palpable P2, right-sided S3 gallop, systolic murmur at left lower sternal border Pulmonary: Clear to auscultation bilaterally. Abdomen: Mild hepatomegaly with tenderness on deep palpation in RUQ. Extremities: 2+ pitting edema bilaterally. Neuro: No focal deficits. Clinical Findings: Echocardiography: Tricuspid Regurgitation jet velocity >3.4 m/s, estimated Pulmonary Artery Systolic Pressure >50 mmHg, moderate right atrial enlargement, Right Ventricular dilation and hypokinesis, flattened interventricular septum. Right Heart Catheterization: Mean Pulmonary Arterial Pressure 35 mmHg, Pulmonary Vascular Resistance 4.5 WU, Pulmonary Artery Wedge Pressure 12 mmHg, confirming pre-capillary pulmonary hypertension consistent with WHO Group 1 (PAH). BNP: Elevated at 520 pg/mL. Imaging: Chest CT showed an enlarged main pulmonary artery (diameter >30 mm), attenuated peripheral vasculature, and no evidence of thromboembolism.
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