Mr Barker has come to visit you in your GP surgery. You establish further history as follows:

• He noticed some breathlessness on vigorous exertion, for example running to catch the bus, six months ago. The breathlessness has only been limiting him when walking slowly, for example on the golf course, for the past two weeks.

• The episodes of breathlessness were initially only on exertion. In the past two days he has also noticed breathlessness when lying in bed at night and as a result has been sleeping using three pillows.

• He has noticed some swelling of his ankles and his socks are leaving marks on the skin when he takes them off at night. He has no cough or sputum and his temperature was normal when he took it at home.

You already know from his records that he is an ex-smoker and had a myocardial infarction treated by angioplasty seven years ago. Following this he was prescribed secondary prevention medications but you notice he hasn’t collected his prescription for a while. On direct questioning he tells you that he stopped his beta-blocker because he thought it was causing tiredness and he was put off taking his statin due to media reports of bad side effects. He is currently only taking Aspirin 75mg OD.