Author: Kenichi Sakuda, Sarah Edwards / Editor: Tim Osborne / Codes: / Published: 14/01/2026
A 55-year-old gentleman presents to the Emergency Department (ED) with a two-week history of bilateral pitting oedema affecting both lower legs up to the knees. Over the past three days, he has developed progressive shortness of breath and orthopnoea requiring three pillows to sleep comfortably.
He has no significant past medical history and takes no regular medications. He denies chest pain, palpitations, or recent travel. There is no family history of cardiac disease.
Initial observations:
- Respiratory rate: 21 breaths/min
- Oxygen saturation: 95% on room air
- Temperature: 36.6 C
- Blood pressure: 216/115 mmHg
- Heart rate: 95 bpm, regular
Examination findings:
- Cardiovascular: Heart sounds I + II + 0, no murmurs or added sounds, JVP not elevated.
- Respiratory: Chest clear to auscultation bilaterally, no wheeze or crepitations
- Abdomen: Soft, non-tender, bowel sounds present, no organomegaly
- Extremities: Bilateral pitting oedema extending to both knees, calves soft and non-tender
- General: Alert, afebrile, no lymphadenopathy
Initial investigations:
- 12-lead ECG: Normal sinus rhythm, no acute changes
- Full blood count: Normal
- Inflammatory markers (CRP, ESR): Normal
- eGFR 64 mL/min/1.73m
- Troponin: Negative
