SOB and Febrile

78yo year old female with 5 days of SOB which has become increasingly worse in the last 24 hours. She is normally independent at home. She is up to date with flu and Covid vaccines. The SOB began as a simple URTI about 10 days ago. Last night she was also febrile. PMHx HT (candesartan) and HC (statin). She is independent at home and has had not recent hospitalisations or immobilisations. She is a non smoker.

When you see her she has had 1L of N saline for a brief period of unstable obs on admission: BP 90/60 and HR 130. 

Her current obs are: BP 110/60 HR 110 temp 38 sats 90% on 6L NP

OE She has widespread wheeze and basal crackles in both lung fields. She has a pansystolic murmur in the mitral area and a faint ESM in the aortic area. Her apex feels hyperdynamic. JVPNE and no pitting oedema or calf swelling/tenderness.

ECG shows a sinus tachycardia with no ST changes

The case will be better for your learning if you go through the lung US images first, go to the Lung US summary and then look at the cardiac images.