Soru

During a routine follow-up appointment, a $65$-year-old female patient complains of increasing difficulty breathing over the last $5$ days. She notes that she can no longer sleep in her bed and has spent the last two nights in a reclining chair. Her medical history includes long-standing hypertension, stable angina, and type 2 diabetes mellitus. She denies any fever, productive sputum, or recent sick contacts. Vital signs reveal a blood pressure of $162/88\text{ mm Hg}$, a heart rate of $95\text{/min}$, and a respiratory rate of $22\text{/min}$. Oxygen saturation is $93\%$ on ambient air. Cardiovascular examination demonstrates elevated jugular venous pressure and an audible S3 gallop. Pulmonary auscultation reveals crackles at the bases of both lungs. Examination of the lower extremities shows significant $2+$ bilateral pitting edema. Laboratory testing is notable for a B-type natriuretic peptide (BNP) level of $920\text{ pg/mL}$, a normal leukocyte count, and normal thyroid-stimulating hormone (TSH) and free T4 levels. An arterial blood gas shows a pH of $7.43$, $\text{pCO}_2$ of $34\text{ mm Hg}$, and $\text{pO}_2$ of $72\text{ mm Hg}$. Which of the following is the most appropriate next step in the pharmacologic management of this patient?