Kardiologischer Fall: 22-jährige Frau mit Beinödemen, Dyspnoe und Fatigue von Joseph Alpert, MD

A 22-year-old graduate student presents to the clinic because of increasing leg edema that has become refractory to the diuretics prescribed by her primary care physician. She also notes increasing dyspnea on exertion and fatigue. She has been previously healthy. Her family history indicates that her mother has a diagnosis of systemic lupus erythematosus. On physical examination, her blood pressure is 104/78 mm Hg, heart rate is 86 beats/min, peripheral oxygen saturation 88% on room air, and the jugular venous pulse is 12 cm of water. Lung auscultation shows no abnormalities. She has 2-3 pitting edema on her lower extremities. Which of the following would you find in this patient?

A 22-year-old graduate student presents to the clinic because of increasing leg edema that has become refractory to the diuretics prescribed by her primary care physician. She also notes increasing dyspnea on exertion and fatigue. She has been previously healthy. Her family history indicates that her mother has a diagnosis of systemic lupus erythematosus. On physical examination, her blood pressure is 104/78 mm Hg, heart rate is 86 beats/min, peripheral oxygen saturation 88% on room air, and the jugular venous pulse is 12 cm of water. On lung auscultation, her lungs are clear. On extremities examination, 2–3 peripheral edema is noted. After several diagnostic studies, a diagnosis of idiopathic pulmonary hypertension is reached. Which of the following is the best initial treatment for this patient?