Patient presents with symptoms suggestive of mitral and tricuspid regurgitation, including dyspnea on exertion, fatigue, peripheral edema, and palpitations.  Physical examination reveals a holosystolic murmur at the apex radiating to the axilla, consistent with mitral regurgitation.  A separate holosystolic murmur is also auscultated at the left lower sternal border, suggestive of tricuspid regurgitation.  Jugular venous distention is noted.  The patient's medical history includes hypertension and hyperlipidemia.  Echocardiography confirms the diagnosis of moderate mitral regurgitation and mild tricuspid regurgitation.  Left ventricular ejection fraction is preserved.  Assessment includes mitral valve disease, tricuspid valve disease, heart failure with preserved ejection fraction, and valvular heart disease.  Plan includes optimization of medical therapy for heart failure management with diuretics and ACE inhibitors.  Patient education provided regarding lifestyle modifications including sodium restriction and regular exercise.  Follow-up echocardiography scheduled in six months to monitor valve function and disease progression.  Differential diagnosis included other causes of dyspnea and edema, such as coronary artery disease and pulmonary hypertension, which were ruled out based on clinical findings and diagnostic testing.  Medical billing and coding will reflect the diagnoses of mitral regurgitation and tricuspid regurgitation with associated heart failure.  The patient's prognosis is generally favorable with appropriate medical management.