Respiratory Cases II

67 yo female with extreme respiratory distress

Patient Chart
VK is a 67-year-old female who is transported by local EMS to the emergency department with extreme respiratory distress that began two hours ago. He is sweating profusely and using all of his accessory muscles to breathe. Heart rate is 114, respiratory rate is 44, temperature is 98.8o F. SpO2 is 80% with the patient breathing oxygen from a nasal cannula at 5 Lpm. He has an occasional cough productive of clear foamy secretions.

Use the Auscultation and Blood Pressure tabs for heart rate, blood pressure and lung sounds.

The patient is placed on a nonrebreathing mask. A stat portable chest radiograph reveals a grossly enlarged left ventricle with increased vascular markings in both bases. Venous blood is drawn for analysis; results reveal a BNP of 550.
Heart Rate:
Blood Pressure: /


Which of the following is the most likely diagnosis?