Acute decompensated heart failure — MCCQE Part 1 MCQ

Correct answer: A — Give oxygen as needed, IV loop diuretic and assess for precipitating causes

Give oxygen as needed, IV loop diuretic and assess for precipitating causes is best because congestion with hypoxaemia and fluid overload indicates acute decompensated heart failure. Prescribe an antibiotic without assessing severity or likely cause is suboptimal because antibiotics are not the default for all respiratory presentations; Discharge without oxygen assessment or safety-netting is suboptimal because oxygenation and work of breathing guide urgency; Request elective pulmonary function testing as the immediate step is suboptimal because spirometry is rarely the first step in an unstable acute presentation; Treat as anxiety without excluding cardiorespiratory disease is suboptimal because anxiety is a diagnosis of exclusion when objective respiratory features are present. Treat the congestion, but always look for triggers such as ACS, arrhythmia, infection and non-adherence.

Reference: CCS Heart Failure Guidelines 2023