Question

A 79-year-old man with a history of heart failure with reduced ejection fraction presents with marked dyspnoea at rest, orthopnoea and confusion. He has cool peripheries, a respiratory rate of 32 breaths per minute, oxygen saturation 88% on air, pulse 120 bpm and blood pressure 80/50 mmHg. Jugular venous pressure is raised and there are widespread crackles. What is the single most appropriate immediate management step?

Accepted Answer

Give intravenous Frusemide, oxygen, and call the critical care team urgently

Answer

Start high-dose oral loop diuretic on the ward

Answer

Arrange elective echocardiography and outpatient review

Answer

Start ACE inhibitor uptitration in the community

Answer

Give sublingual GTN and send home if symptoms improve

Practice question