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Heart Failure (HFrEF) — EECC MCQ

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HardCardiologyHeart Failure (HFrEF)EECC

A haemodynamically stable patient has abrupt tearing chest pain and a new pulse deficit. eGFR is 24 mL/min/1.73 m². What is the best initial definitive imaging test?

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Correct answer: B — Urgent CT angiography of the entire aorta

Suspected acute aortic syndrome is immediately life-threatening, and renal dysfunction should not cause a dangerous diagnostic delay. In a stable patient, rapid ECG-gated CT angiography extending through the aorta is usually the definitive first test; TOE is valuable when unstable or CT is unsuitable. Contrast risk should be mitigated, not allowed to outweigh the acute risk. Apply this conclusion only to the clinical circumstances stated, with appropriate specialist review, contraindication checks, shared decision-making and follow-up. Reassess if the physiology, treatment response or competing risk changes. The competing options would require a different haemodynamic profile, diagnosis, procedural indication or risk balance from the one described here.

Reference: 2024 ESC Guidelines for peripheral arterial and aortic diseases. https://www.escardio.org/guidelines/clinical-practice-guidelines/peripheral-arterial-and-aortic-diseases/