Breathlessness and Oedema

🗒️ Question

A 78 year old woman with end-stage heart failure presents to the palliative care clinic with worsening fatigue and breathlessness at rest. She reports episodes of orthopnoea and requires increasing support from her family for daily activities. She has had multiple hospital admissions for decompensated heart failure over the past year.

On examination, her blood pressure is 98/64 mmHg, heart rate is 104 bpm and irregular, and her respiratory rate is 24 breaths per minute. There is bilateral pitting oedema to her thighs, and her jugular venous pressure is elevated. Bibasal crepitations are present on auscultation.

Investigations:

• BNP: 650 pg/mL (<100)

• Serum creatinine: 145 µmol/L (60–120)

• eGFR: 45 mL/min/1.73 m² (>90)

• Serum potassium: 5.0 mmol/L (3.5–5.3)

What is the most appropriate investigation to guide further palliative care management?

(A) Cardiac MRI

(B) Chest X-ray

(C) Echocardiography

(D) Serum troponin

(E) Right heart catheterisation