Breathless with raised NT-proBNP — CCE clinical encounter

CCE-style clinical encounter: a 66-year-old with new exertional dyspnoea, raised NT-proBNP and newly reduced EF on echo. The candidate must confirm the diagnosis, initiate all four HFrEF pillars with monitoring, and safety-net for decompensation.

clinical encounter with role-player (CCE format)2 min readVerification in progress

Prompt

A 66-year-old retired plumber attends for his NT-proBNP and echo results: NT-proBNP 1450 pg/mL, LVEF 32% with global hypokinesis. He has three weeks of exertional breathlessness and now mild ankle swelling. He is anxious about 'a bad heart' and asks whether he will need an operation.

Objectives

Deliver the diagnosis honestly and hopefully — modern therapy has transformed HFrEF outcomes. ^[1]
Confirm baseline work-up: ECG, bloods (FBE, UEC, LFTs, iron studies, glucose/HbA1c), weight, and ischaemia assessment. ^[1]
Initiate all four pillars at appropriate starting doses with a titration calendar. ^[2]
Set the monitoring rhythm: urea/electrolytes 1–2 weeks after each change; BP and symptom checks. ^[3]
Safety-net for decompensation and explain device assessment as a later possibility, not a threat. ^[2]

References3Show

[1]McMurray JJV, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure (PARADIGM-HF) N Engl J Med, 2014.PMID 25176015
[2]McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) N Engl J Med, 2019.PMID 31535829
[3]Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF) Lancet, 2022.PMID 36356631

Breathless with raised NT-proBNP — CCE clinical encounter

clinical encounter with role-player (CCE format)2 min readVerification in progress

Objectives

Deliver the diagnosis honestly and hopefully — modern therapy has transformed HFrEF outcomes. ^[1]

Confirm baseline work-up: ECG, bloods (FBE, UEC, LFTs, iron studies, glucose/HbA1c), weight, and ischaemia assessment. ^[1]

Initiate all four pillars at appropriate starting doses with a titration calendar. ^[2]

Set the monitoring rhythm: urea/electrolytes 1–2 weeks after each change; BP and symptom checks. ^[3]

Safety-net for decompensation and explain device assessment as a later possibility, not a threat. ^[2]

References3Show

[1]McMurray JJV, Packer M, Desai AS, et al. Angiotensin-neprilysin inhibition versus enalapril in heart failure (PARADIGM-HF) N Engl J Med, 2014.PMID 25176015
[2]McMurray JJV, Solomon SD, Inzucchi SE, et al. Dapagliflozin in Patients with Heart Failure and Reduced Ejection Fraction (DAPA-HF) N Engl J Med, 2019.PMID 31535829
[3]Mebazaa A, Davison B, Chioncel O, et al. Safety, tolerability and efficacy of up-titration of guideline-directed medical therapies for acute heart failure (STRONG-HF) Lancet, 2022.PMID 36356631