mrcem2-0158

mrcem2-0158

A 60 year old female presents to the emergency department complaining of increasing shortness of breath. The patient reports feeling more fatigued and breathless with minimal exertion over the past few months, but in the past few days, she has been experiencing breathlessness even at rest. She informs you that she has been taking aspirin, ramipril, bisoprolol, and rosuvastatin for the past 5 years since she had a minor heart attack. Upon examination, you observe prominent neck veins, bilateral lung crepitations that are worse at the bases, faint heart sounds, and pitting edema below the knee. The patient’s vital signs are as follows:

Blood pressure: 130/84 mmHg
Pulse rate: 90 bpm
Respiration rate: 23 bpm
Temperature: 37.0ºC
Oxygen saturation: 93% on room air

What would be the most appropriate initial treatment for this patient?