MRCP2-0200

MRCP2-0200

A 67-year-old woman presents to the hospital with severe acute dyspnoea and progressive breathlessness over the past three months. She denies any chest pain. On examination, her pulse is 120 beats per minute and regular, blood pressure is 95/55 mmHg, and jugular venous pressure is elevated to the angle of the jaw. Bilateral fine inspiratory crackles to the mid zones are heard on chest auscultation, and haemorrhages are observed in both fundi. Her laboratory results show low haemoglobin, haematocrit, MCV, MCH, white cell count, and platelets. The ECG shows left bundle branch block, which had been documented previously. Intravenous furosemide results in an excellent diuresis. What is the most appropriate immediate step in her management?