Night-time breathlessness and frothy sputum: acute decompensated heart failure

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Educational simulation. Not for real patient care and not a substitute for supervised training. Always follow local protocols.

What you will practise

Recognise acute cardiogenic pulmonary oedema from the history, examination and chest radiograph.
Prioritise sitting the patient upright, oxygenation, monitoring and early intravenous diuretic therapy.
Explain the role of vasodilators and of non-invasive ventilation, and why intravenous fluids and routine beta-blocker boluses are harmful.
Identify and treat precipitants of decompensation, including ischaemia, arrhythmia, infection, drugs and non-adherence.
Describe monitoring during diuresis, including fluid balance, weight, electrolytes and renal function.
Outline discharge planning and long-term disease-modifying therapy for heart failure with reduced ejection fraction.

A patient with bilateral renal artery stenosis develops a marked fall in GFR after starting an ACE inhibitor. What is the best explanation?
A patient on lisinopril develops a persistent dry cough. Which mechanism most likely explains it?
Which patient is most at risk of acute kidney injury after starting an ACE inhibitor?
A patient with heart failure cannot tolerate an ACE inhibitor because of cough. Which alternative is appropriate, and why is cough much less likely?
A patient with severe bradycardia and hypotension after a beta-blocker overdose does not respond to atropine. Which agent bypasses the blocked receptor and increases cAMP in cardiac cells?