Differential diagnosis of acute pulmonary oedema (left ventricular failure/LVF)
| Subjective assessment | Objective examination |
|---|---|
| History of: | Severe dyspnoea increased by recumbent positioning. |
| Pre-existing heart disease (undiagnosed chest pain, angina, myocardial infarction, aortic or mitral valve disease, tachyarhythmias) | May be worse at night. |
| Cough producing white frothy sputum, sometimes tinged pink (this may be copious = frank pulmonary oedema) | |
| Increasing dyspnoea | Crackles over affected area |
| Increasing exercise intolerance | Raised JVP |
| Rheumatic fever | Third heart sound (requires practice to differentiate!) |
| Lack of compliance to prescribed medications | Mitral murmur (requires practice to differentiate!) |
| Failure to cope with normal activities of daily living | Possible arrhythmias |
| Evidence of a wide range of drugs used to treat cardiac conditions may be found, including β blockers, calcium channel blockers, ACE inhibitors, nitrates, aspirin, diuretics and anti-arrhythmics | Hypotension |
| Chest pain may be present | |
| Dependent pitting oedema (generalised heart failure) |