A 72-year-old woman presents with increasing breathlessness over 3 days, orthopnoea, and paroxysmal nocturnal dyspnoea. PMH: Hypertension, atrial fibrillation. O/E: Appears distressed. Bilateral basal crackles and pitting ankle oedema present.
Observations & Investigations:
- HR: 110/min (Irregularly irregular)
- BP: 165/95 mmHg
- RR: 28/min
- SpO₂: 88% on room air
- CXR: Upper lobe venous diversion, cardiomegaly, and bilateral perihilar shadowing.
What is the MOST appropriate initial management?
A
Oxygen therapy, nebulised salbutamol, IV hydrocortisone, and oral prednisolone
B
Continuous positive airway pressure (CPAP), IV furosemide, and IV antibiotics
C
Oxygen therapy, IV furosemide 40-80mg, GTN infusion, and sit patient upright
D
Oxygen therapy, IV furosemide 40mg, and arrange urgent echocardiography
E
Non-invasive ventilation (BiPAP), IV morphine, and urgent cardiology referral