Heart Failure Scenario

What is likely the most beneficial first action to take for this patient?

You focus first on reassuring the patient, recognising that her anxiety is impeding your assessment. She tells you she has been unwell for several days, but overnight her breathing has worsened significantly. She also reports that she cannot lie flat without feeling extremely breathless. What is this symptom called? 

You begin gathering observations: HR 109, SpO₂ 86%, BP 115/86, RR 28, Temp 36.9°C, BM 5.4 mmol/L. Auscultation reveals bilateral basal crackles and slight wheeze. What is this patient’s NEWS score?

You attempt to obtain a brief history to guide your differential and treatment. The patient is unsure of her exact medical background but admits to experiencing long-term breathing difficulties. She mentions that overnight she began coughing up pink, frothy sputum. What does this usually indicate? 

With the patient’s presentation and history pointing towards pulmonary oedema, which treatment should be prioritised?

As you prepare the oxygen mask, the patient states she has COPD. What oxygen saturation target should you now aim for?

Given the patient has COPD, does this change the NEWS score when using the updated tool?

While the NEWS score may be lower, you are still concerned. COPD complicates your differential diagnosis. Which other signs and symptoms might help confirm that this episode is due to acute heart failure?

Which of the following medications could indicate a known history of heart failure in this patient?

The patient’s medication history and clinical signs are consistent with acute heart failure. You consider GTN as the next step. What is the minimum systolic blood pressure required to administer GTN?

The patient’s systolic BP is above 110 mmHg, and you decide to administer GTN. What additional treatment options should you consider if they are available to you?

After treatment, the patient’s condition improves significantly. What further observation should be completed in all heart failure patients? 

If you identify ischaemic changes on the ECG suggesting myocardial infarction, should you consider PPCI referral, even if the patient is acutely unwell and unable to lie flat?

Fortunately, the ECG shows no signs of ischaemia, and your local A&E is now the most appropriate destination. However, given the improvement in her symptoms, is it appropriate to discharge the patient at home?

At A&E, what interventions might the hospital initiate to support this patient’s care? 

Which of the following signs is more commonly associated with right-sided heart failure?

What is the leading cause of heart failure in the UK?