Case 1

A 68-year-old man presents with an acute onset of breathlessness overnight.  He has a history of intermittent chest pain in recent days but has no pain today.  He has been awake for most of the night trying to get comfortable until his wife called the emergency services.

List five causes or precipitating factors associated with cardiogenic pulmonary oedema.

The paramedics administered high-flow O₂, aspirin and GTN spray. 

On examination, the respiratory rate is 30/min with saturations of 94%, heart rate is 100/min with a gallop rhythm but no murmurs, BP 80/40.  His skin is cold and he is drenched in sweat. On auscultation, he has crepitations throughout his chest.  He has become increasingly agitated since moving across from the ambulance trolley.

The 12-lead ECG performed en route is shown below:

Which of the following is the most likely diagnosis?