The patient is 77-year-old female who presents to the ED complaining of increasing shortness of breath over the past several days. She has orthopnea. She is also had a significant gain in weight over the past week. Her medical history is significant for a past CVA. She is on Plavix, Lipitor and Xeralto. She is on for her chronic afib. In the ED her BNP is found to be 2886. She is treated in the ED with a Lasix. She does have some diuresis but not significant enough known to make her comfortable. She is still suffering from orthopnea she is therefore admitted acutely inpatient patient. The patient is also known to have a cardiomyopathy with an ejection fraction approximately 45%. It is noted by the by the cardiologist that despite
