If this is a cardiac emergency, call 10177 (ambulance) immediately. Do not drive yourself.
Recognising Acute Decompensated Heart Failure
Go to the ER immediately if you experience any of the following:
- Sudden severe breathlessness — you cannot breathe properly lying down or even sitting up
- Coughing up pink frothy sputum — sign of acute pulmonary oedema
- Rapid weight gain of 2–3kg in 24–48 hours (fluid retention)
- Severely swollen legs or abdomen (new or rapidly worsening)
- Low blood pressure + confusion + cold, clammy skin — cardiogenic shock; call 10177 immediately
- Sudden loss of consciousness or collapse — call 10177 immediately; may indicate life-threatening arrhythmia
Cardiogenic shock — heart failure so severe the heart cannot maintain blood pressure — is immediately life-threatening. Call 10177 without delay.
What Your Medical Aid Must Cover
| Emergency | PMB Status | Notes |
|---|---|---|
| Acute decompensated heart failure (hospital admission) | Yes — PMB | IV diuresis, oxygen, haemodynamic monitoring |
| Acute pulmonary oedema | Yes — emergency PMB | May require non-invasive ventilation (CPAP/BiPAP) |
| Cardiogenic shock | Yes — emergency PMB | ICU; inotropic support (dobutamine, levosimendan) |
| Life-threatening arrhythmia (VT/VF) | Yes — PMB (dysrhythmia DTP) | Defibrillation; ICD interrogation if implanted |
| ICD shock / inappropriate ICD discharge | Yes — PMB | ER assessment and ICD device check |
| Acute MI triggering heart failure | Yes — PMB (MI DTP) | Emergency PCI if indicated |
Emergency Numbers
Ambulance (national): 10177 ER24: 084 124 Netcare 911: 082 911 Police: 10111
The "2kg Rule" — When to Act Before It Becomes an Emergency
Many heart failure admissions can be prevented by acting early on warning signs. Most cardiologists recommend:
- Weigh yourself daily at the same time (morning, after toilet, before breakfast)
- If your weight increases by more than 2kg in 48 hours, call your cardiologist — don't wait for an appointment
- Your cardiologist may have pre-authorised a "wet day" protocol — an extra dose of furosemide taken at home when your weight spikes before hospital is needed
Discuss this protocol with your cardiologist. It reduces hospitalisations.
At the Hospital — PMB in Practice
On arrival at the ER with acute decompensated heart failure: 1. Hand your medical aid card to the admissions desk immediately. 2. If using a private hospital ER, your scheme will be contacted for emergency authorisation — this happens in the background; it does not delay clinical treatment. 3. For schemes that require pre-authorisation: in a genuine emergency, treatment proceeds first; your scheme must cover the admission retrospectively under PMB if it was an emergency.
If you have gap cover: Call your gap cover provider within 24–48 hours of admission to register the in-hospital event. In most cases, the hospital does this automatically if gap cover information is on file — confirm beforehand.
If Your ICD Fires
If your implanted ICD delivers a shock: 1. Sit or lie down. 2. If you feel well after a single shock and it was a one-off, call your cardiologist or the device clinic immediately — go to the ER if your cardiologist is unavailable. 3. If you receive multiple shocks (ICD storm), call 10177 immediately.
An ICD firing in a heart failure patient requires assessment — whether the shock was appropriate (life-saving) or inappropriate (faulty sensing) matters for device programming.
ICD shock assessment is PMB-covered under the cardiac/dysrhythmia DTP.
If Your Scheme Declines the Hospitalisation
If your scheme declines to fund an acute heart failure hospital admission:
- Request written reasons.
- Acute decompensated heart failure is a PMB DTP. Any refusal is a potential PMB breach.
- Your cardiologist should submit an immediate clinical motivation with the diagnosis, NYHA class, clinical deterioration, and treatment administered.
- Internal appeal — submit with clinical documentation.
- Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za. Escalate without delay if a genuine emergency admission is being denied.
Mental Health in Heart Failure
Depression is present in 30–40% of heart failure patients and significantly worsens outcomes. Anxiety about the next hospitalisation or death is common. If you are struggling emotionally: - Tell your cardiologist — depression should be managed as part of your cardiac care - SADAG: 0800 567 567 (24-hour support) - Psychology sessions are funded from your day-to-day mental health benefit
Resources and Helplines
Emergency: 10177 | ER24: 084 124 | Netcare 911: 082 911 Heart and Stroke Foundation SA: heartfoundation.co.za SADAG: 0800 567 567 (24-hour) Council for Medical Schemes: 0861 123 267 | www.medicalschemes.co.za Talk to Eldon →