19th February 2025

A 72-year-old gentleman with a history of coronary artery disease presents to the emergency department with a four-hour history of central crushing chest pain radiating to his left arm.

A 72-year-old gentleman with a history of coronary artery disease presents to the emergency department with a four-hour history of central crushing chest pain radiating to his left arm. On initial assessment, his observations are normal and examination is unremarkable. He suddenly starts feeling short of breathing in the department and you assess his observations, which show a blood pressure of 104/54, heart rate of 101, saturations of 88% on room air and a respiratory rate of 28. On examination, there are fine bibasal inspiratory crackles, a regular pulse and non-displaced apex beat with a new pansystolic murmur. You suspect this patient has pulmonary oedema. What is the most likely aetiology of their pulmonary oedema?

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