Table 4

Differential diagnosis of acute pulmonary oedema (left ventricular failure/LVF)

Subjective assessmentObjective 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 dyspnoeaCrackles over affected area
    Increasing exercise intoleranceRaised JVP
    Rheumatic feverThird heart sound (requires practice to differentiate!)
    Lack of compliance to prescribed medicationsMitral murmur (requires practice to differentiate!)
    Failure to cope with normal activities of daily livingPossible 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-arrhythmicsHypotension
Chest pain may be present
Dependent pitting oedema (generalised heart failure)