Clinical evaluation of heart failure: A clinical case discussion of a patient with rheumatic heart disease

A 44-year-old male with no prior cardiovascular risk factors presented with exertional dyspnea and dry cough followed by features of the right heart failure including early satiety and pedal edema. He had congestive heart failure at presentation with cardiac auscultation revealing murmurs of mitral regurgitation at the apex and tricuspid regurgitation at the lower left sternal border and aortic stenosis at the right second intercostal space. He was diagnosed as case of rheumatic heart disease based on clinical and echocardiographic assessment. The following clinical case discussion highlights some common questions that come to mind during evaluation of such patients. Physical examination findings in a patient presenting with heart failure syndrome are highlighted in particular.