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Breathless and swollen

Clinical caseCardiology2 min
Breathless and swollen

A 67-year-old man with known heart failure with reduced ejection fraction presents with three days of worsening breathlessness, orthopnea, and bilateral ankle swelling. He is euvolemic on exam apart from crackles at both lung bases and pitting edema to the knees. Oxygen saturation is 91% on room air.

What is the most appropriate first-line management step?