This case presents a patient with cardiopulmonary instability.  The patient was a man born in 1939, who had a history of diabetes, hypertension, chronic heart failure due to ischemic cardiomyopathy and a reduced left-ventricular ejection fraction (HFrEF) measured initially at 35%, and chronic renal failure.  He was on a full panel of medications including an antidepressant, oral antidiabetic, aspirin, statin, diuretic, warfarin, aldosterone inhibitor, ACE inhibitor, β-blocker, and ivabradine (a heart-rate reducing agent indicated in patients with symptomatic heart failure, reduced ejection fraction, and persistently elevated heart rate despite otherwise maximal medical therapy).  This patient’s last medical event was a new admission for pulmonary edema.