13th March 2024

A 54-year-old male is referred to the cardiology team with a 4-day history of worsening shortness of breath on exertion, difficulty lying flat in bed and fatigue.

A 54-year-old male is referred to the cardiology team with a 4-day history of worsening shortness of breath on exertion, difficulty lying flat in bed and fatigue. His wife explains he has had a fever, headache and blocked nose for a few days prior to the onset of his breathing problems. On examination, he is struggling to speak in full sentences, and chest auscultation reveals coarse crackles throughout both lung fields. JVP is raised at 4.2cm. His latest observations are BP 87/64 mmHg, HR 136 bpm, SO2 91% on 15L O2. RR 33 and temperature of 37.9°C. ECG reveals ST segment depression in leads I, III, aVF, V2-V6. An urgent portable CXR shows bilateral moderate pleural effusions, upper lobe diversion and Kerley B lines. An urgent bedside echocardiogram shows global systolic dysfunction and biventricular dilatation. He has already been administered a stat dose of furosemide 40 mg intravenously, but his breathing has shown no improvement, and you are concerned about his latest blood pressure reading. What is the next most appropriate intervention you would consider?

Select the SINGLE most appropriate option from the list below. Select ONE option only.