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GERICLINICS

Clinical case · Heart failure

Breathless again three weeks after discharge

A 79-year-old man with heart failure with reduced ejection fraction is readmitted with fluid overload after starting an anti-inflammatory. Treat the decompensation, then build safe, evidence-based treatment for a frail older patient.

Advanced 20 minNeeds clinical reviewPro · free in beta

You will learn to

  • Identify precipitants of decompensated heart failure, including medicines
  • Interpret natriuretic peptides in an older person with kidney disease and anaemia
  • Plan decongestion, then the four drug classes for HFrEF, iron replacement and follow-up, adapted to frailty and cognition

Presentation

Step 1 of 10

A 79-year-old man is admitted with three days of worsening breathlessness. He cannot lie flat and his ankles have swollen. His wife says his weight has gone up by 4 kg in ten days.

He was discharged three weeks ago after his first admission with heart failure.

References

  1. Youn JC, Kim D, Cho JY, et al. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Treatment. Int J Heart Fail. 2023;5(2):66–81. doi:10.36628/ijhf.2023.0011 · PubMed 37180564
  2. Cho JY, Cho DH, Youn JC, et al. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Definition and Diagnosis. Int J Heart Fail. 2023;5(2):51–65. doi:10.36628/ijhf.2023.0009 · PubMed 37180563
  3. Park SM, Lee SY, Jung MH, et al. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Management of the Underlying Etiologies and Comorbidities of Heart Failure. Int J Heart Fail. 2023;5(3):127–145. doi:10.36628/ijhf.2023.0016 · PubMed 37554691
  4. Hyun J, Cho JY, Youn JC, et al. Korean Society of Heart Failure Guidelines for the Management of Heart Failure: Advanced and Acute Heart Failure. Int J Heart Fail. 2023;5(3):111–126. doi:10.36628/ijhf.2023.0019 · PubMed 37554692
  5. Jamil Y, El Ghazawi A, Farhat K, et al. Representation of Older Adults in the AHA/ACC/HFSA Guideline for the Management of Heart Failure. JACC Adv. 2025;4(12 Pt 1):102135. doi:10.1016/j.jacadv.2025.102135 · PubMed 41128709

Last updated 2026-10-21.

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