Patient presents with symptoms suggestive of severe tricuspid regurgitation.  Presenting complaints include progressively worsening dyspnea on exertion, fatigue, and peripheral edema.  Physical examination reveals jugular venous distension, a holosystolic murmur at the left lower sternal border that increases with inspiration, and hepatomegaly.  The patient reports a history of [mention underlying cause if known, e.g., rheumatic heart disease, infective endocarditis, pulmonary hypertension, or congenital heart defect].  Echocardiography confirms severe tricuspid regurgitation with evidence of [describe echo findings e.g., dilated right atrium and ventricle, severe tricuspid annular dilatation,  central jet].  Right heart catheterization may be considered for further hemodynamic assessment and to guide management decisions.  Differential diagnosis includes other causes of right heart failure such as pulmonary stenosis and pulmonary embolism.  Assessment:  Severe tricuspid regurgitation. Plan:  Diuretic therapy initiated for symptom management.  Referral to cardiology for consideration of tricuspid valve surgery or percutaneous intervention is recommended.  Patient education provided regarding the disease process, medication management, and the importance of follow-up appointments.  ICD-10 code I07.1 (tricuspid valve insufficiency) is documented.  Further diagnostic evaluation and treatment will be determined based on the patient's clinical course and response to therapy.