MRCP2-0210

MRCP2-0210

A 75-year-old man presents to his GP with gradual onset of shortness of breath. He can only walk 10 yards before needing to rest and cannot lie flat. He has been sleeping in an armchair for the past three months due to this.

The patient has a history of hypertension and two previous heart attacks. On examination, his apex beat is displaced to the 7th intercostal space in the left mid-axillary line and there are crackles in both lung bases. His JVP is elevated at 5cm and he has swelling in both legs.

Lab results show a troponin level of <20 ng/ml and a B-natriuretic peptide level of 14,000 ng/L (normal range 0-200). A chest X-ray reveals cardiomegaly and increased shadowing in the perihilar areas. His ECG shows a QRS of 110ms and large volume complexes in chest leads. What is the proven intervention to reduce mortality in this case?