72 year old with progressive dyspnea for days

History 72-year-old man (171 cm, 88 kg), presentation due for days progressive dyspnea, NYHA III Preliminary diagnoses Known ischemic cardiomyopathy with coronary three-vessel disease with Zn CABG in 1992 and re-ACB 2006 Zn pacemaker implantation (2-chamber pacemaker) 2011 / li> PAD city. III Zn Media infarction left Cardiovascular risk factors: arterial hypertension, hyperlipidemia, positive family history, continued nicotine consumption Medication ASA 100 mg  Simvastatin 40 mg  bisoprolol 5 mg  Ramipril + Hydrochlorothiazide 25.5  mg amlodipine 10 0-1-0  0-0-1  1-0-0  1-0-0  1-0-0 Physical examination findings RR 105/70 mmHg.

pulse 89 / min. Rhythmic heart action, with systolic murmur over apex pm,  moist RG's both sides basally,  significant lower leg edema Chemical and laboratory apparatus and findings Laboratory sodium 129 mmol / l, creatinine 2.0 mg / dl, GFR 32 ml / min / 1.73…