AcuteCVDays 2026 - Week 5 - Website

A 72-year-old woman with dilated cardiomyopathy (EF 20%) and a history of 2 prior HF hospitalizations presents with acute decompensation. BP 95/65 mmHg, HR 105 bpm, warm extremities, bilateral crackles up to mid-lung fields, BNP 4,800 pg/mL, creatinine 1.9 mg/dL (baseline 1.4). She is currently on furosemide 80 mg/day, sacubitril/valsartan, and carvedilol.

According to the 2023 ESC HF Focused Update, what is the most appropriate initial diuretic strategy?

A - Maintain oral furosemide and add metolazone

B – Initiate IV loop diuretic at a dose ≥ the equivalent of her chronic oral dose

C - Hold diuretics until hemodynamic stabilization is confirmed

D – Discharge with follow-up.Start ultrafiltration immediately given elevated creatinine

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