5th May 2025

Mrs Chatterjee is a 79-year-old lady with a past medical history of ischaemic heart disease, congestive cardiac failure (ejection fraction 45%), hypertension, type 2 diabetes mellitus and hypercholesterolemia.

Mrs Chatterjee is a 79-year-old lady with a past medical history of ischaemic heart disease, congestive cardiac failure (ejection fraction 45%), hypertension, type 2 diabetes mellitus and hypercholesterolemia. She had a right ventricular pacemaker inserted for complete heart block 15-years ago. At her routine follow-up in pacing clinic, you note she is short of breath walking from the waiting area into the consultation room. On asking, she discloses struggling with daily activities such as walking upstairs and increasing ankle swelling. She denies any chest pain, syncope or palpitations. On examination, you notice bi-basal coarse crackles at the lung bases with mild pitting oedema to the knees bilaterally. The remainder of the physical examination is unremarkable. Her GP recently started her on Frusemide 20mg OD PO. What would be the next most appropriate step in her management? 

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