Typical exam stem
A 65-year-old patient has progressive exertional dyspnoea, orthopnoea and bilateral ankle swelling. How would you evaluate and manage the patient?
Active exam mode
Plan the case before reading, then mark sections, reveal pearls and self-rate the viva.
1. Sixty-second answer plan
1:00Before reading the notes, say or write your assessment, investigations and management structure.
2. Section checklist
Mark each section only after you can explain its main decision points without reading.
3. Exam-pearl flashcards
Try to predict the pearl before revealing it.
4. Viva drill
Answer aloud before rating yourself. Anything marked “review” stays visible in your progress.
What are common causes of acute decompensation in a patient with known heart failure?
Progress is saved on this device. Use “Reset session” when you want a fresh attempt.
Build the diagnosis from syndrome, cause and trigger
Heart failure is a clinical syndrome caused by structural or functional cardiac abnormality. In an exam, avoid stopping at the label. State the syndrome, estimate whether the presentation is acute or chronic, identify likely aetiology and look for a precipitant of decompensation.
Common causes include ischaemic heart disease, hypertension, valvular disease, cardiomyopathy and arrhythmia. Frequent precipitants include infection, myocardial ischaemia, uncontrolled blood pressure, rapid atrial fibrillation, anaemia, renal dysfunction, medication interruption and excess salt or fluid intake.
High-yield clinical features
- Symptoms: exertional dyspnoea, orthopnoea, paroxysmal nocturnal dyspnoea, fatigue, oedema and reduced exercise tolerance.
- Signs of congestion: raised JVP, basal crackles, peripheral oedema, ascites and hepatomegaly.
- Signs suggesting the cause: murmurs, irregular pulse, displaced apex beat, previous infarction or features of cardiomyopathy.
- Signs of poor perfusion: cool peripheries, hypotension, confusion and oliguria.
Investigations and phenotype
- ECG and chest radiograph provide rhythm, ischaemia and congestion clues but neither alone confirms or excludes heart failure.
- Natriuretic peptides support diagnosis when available and are particularly useful when the cause of breathlessness is uncertain.
- Echocardiography defines ventricular function, chamber size, valves and important structural causes.
- Check full blood count, renal function, electrolytes, liver tests, glucose and thyroid function where clinically appropriate.
- Classify by left ventricular ejection fraction because treatment and prognosis differ across reduced, mildly reduced and preserved EF phenotypes.
Management logic
In acute decompensation, first stabilise airway, breathing and circulation, identify pulmonary oedema or shock, provide oxygen when hypoxaemic and treat congestion and the precipitating cause. In chronic HFrEF, exam answers should show knowledge of disease-modifying therapy rather than relying only on a diuretic. Contemporary treatment is built around neurohormonal blockade and SGLT2 inhibition, with additional therapies selected according to rhythm, renal function, blood pressure and comorbidity.
Diuretics improve congestion but are not a substitute for disease-modifying treatment. HFpEF management includes control of congestion and comorbidities, with evidence-based therapies selected according to current guidance.
Guideline source for further reading
This page is an original exam-revision summary. For clinical decisions, use current local protocols and the primary guidance below.