19th February 2025

An 88-year-old woman with a background of previous MI, type 2 diabetes mellitus, hypertension, aortic stenosis and frailty presents with acute breathlessness to the emergency department.

An 88-year-old woman with a background of previous MI, type 2 diabetes mellitus, hypertension, aortic stenosis and frailty presents with acute breathlessness to the emergency department. She denies chest pain. She had a recent admission a week ago at a different hospital where she developed an AKI and some of her medications, including her regular diuretics, were held.

She is found to be hypoxic with sats of 85% on air, and oxygen therapy via a nasal cannula is applied to maintain normal target saturations. Her blood pressure is 130/75. She is afebrile.

On examination, she has bibasal fine inspiratory crepitations, a raised JVP and significant bilateral pedal oedema. Her ECG shows normal sinus rhythm with evidence of left ventricular hypertrophy but no new ST or T wave changes.

Her bloods show static, low troponins and her inflammatory markers are not raised. Her NT pro-BNP is raised and her renal function has recovered back to baseline.

Chest x-ray shows cardiomegaly, bilateral medial patchy opacification and bilateral small pleural effusions.

What is the appropriate next stage of management?

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