ModerateCardiovascularAcute decompensated heart failure with pulmonary oedemauk-plab-1
A 76-year-old woman with a history of long-standing hypertension presents with acute onset severe breathlessness at rest and orthopnoea. She is tachypnoeic with widespread crackles to the mid zones bilaterally and a gallop rhythm. Oxygen saturations are 88% on air, blood pressure 170/100 mmHg and she has cool peripheries. What is the most appropriate immediate pharmacological treatment in addition to high-flow oxygen and sitting her upright?