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Acute left ventricular failure — DIPIMC MCQ

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HardMedical EmergenciesAcute left ventricular failureDIPIMCDipIMC

An elderly woman has acute severe breathlessness with pink frothy sputum, widespread fine crackles, a blood pressure of 180/100, an SpO2 of 88% and profuse sweating.

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — Sit her upright, give high-flow oxygen and GTN, consider CPAP and transfer rapidly

Explanation lettering: D = shown as A · E = shown as C · C = shown as D · A = shown as E

Acute cardiogenic pulmonary oedema is managed by sitting the patient upright, giving oxygen and nitrates to reduce preload, considering CPAP, and transferring rapidly; the hypertension supports a cardiogenic rather than hypovolaemic picture. Lying the patient flat and giving fluids (A) worsens the pulmonary oedema, and salbutamol (B) treats bronchospasm, not failure. Treat the high filling pressures - upright, oxygen, nitrates and CPAP.

Reference: JRCALC Clinical Guidelines; NICE acute heart failure