5th May 2025

A 67-year-old man presents with sudden onset chest pain, palpitations and breathlessness.

A 67-year-old man presents with sudden onset chest pain, palpitations and breathlessness. He had an MI 8 years ago after which he had a CABG. He has had exertional breathlessness and orthopnoea getting gradually worse over the last few years. An angiogram 2 years ago documented patent grafts, and an echocardiogram showed extensive anteroseptal akinesis with an EF of 30%. He is on aspirin, ramipril, simvastatin, ezetimibe, furosemide and bisoprolol. On examination he is clammy, with a HR 132 bpm and BP 80/60. JVP is not elevated, there are bibasal crepitations but no peripheral oedema. What is the immediate management?

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