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Acute decompensated heart failure — MCCQE Part 1 MCQ

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ModerateDyspneaAcute decompensated heart failureMCCQE Part 1

A 74-year-old woman with heart failure has worsening orthopnoea, ankle swelling, raised JVP, bibasal crackles, oxygen saturation 88% and pulmonary oedema on chest radiograph. Which of the following is the most appropriate next step?

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Correct answer: D — Give oxygen, intravenous loop diuretic and assess for precipitating causes

Give oxygen, intravenous loop diuretic and assess for precipitating causes is the single best answer because the age, timing, examination findings and investigations in the vignette fit Acute decompensated heart failure better than the alternatives. The most tempting distractor is less appropriate because it either treats a neighbouring presentation, delays a time-critical intervention, or ignores a key discriminator in the stem. The remaining options are suboptimal because they would miss the diagnosis, use an investigation or treatment in the wrong sequence, or fail to address safety and follow-up. Canadian practice should be anchored to CCS heart failure guidelines, with attention to acuity, safety-netting and local provincial pathways.

Reference: CCS heart failure guidelines