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Cardiac Oedema — RACP Adult Medicine MCQ

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EasyCardiologyCardiac OedemaRACP Adult Medicine

A 70-year-old woman with heart failure (LVEF 25%) presents with bilateral pitting oedema, elevated JVP (10 cm), hepatomegaly, and bilateral basal crackles. BNP is 2500 pg/mL. She has been non-adherent to her diuretics. What is the mechanism of oedema?

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Correct answer: C — Right heart failure

Bilateral pitting oedema with elevated JVP, hepatomegaly, pulmonary congestion, and elevated BNP in HFrEF is cardiac oedema from right (and biventricular) heart failure. Mechanism: sodium and water retention (RAAS activation, ADH, reduced renal perfusion) + elevated venous pressure (hepatic congestion, peripheral oedema). Treatment: IV furosemide (bolus then infusion), fluid restriction, salt restriction, and reinstate/optimise HF medications.

Reference: NHFA/CSANZ – 2023 – Acute Heart Failure; ESC 2021