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Acute decompensated heart failure — MCCQE Part 1 MCQ

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ModerateDyspneaAcute decompensated heart failureMCCQE Part 1

A 76-year-old man with known HFrEF presents with orthopnoea, bilateral crackles, raised JVP and pitting oedema. Chest radiograph shows pulmonary oedema and BNP is markedly elevated. Which of the following is the most appropriate initial treatment?

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Correct answer: A — Intravenous loop diuretic with monitoring of renal function and electrolytes

Congestion with pulmonary oedema in known heart failure should be treated with intravenous loop diuresis and careful monitoring. Fluids and aggressive beta-blocker initiation can worsen acute decompensation; beta-blockers are optimized once stable. Antibiotics alone are inadequate unless infection is clearly driving the presentation.

Reference: CCS/CHFS heart failure guidelines