72F with CHF/CKD admitted with acute volume overload 2 days ago. Dyspnoea improving on IV furosemide. Tolerating oral intake. Denies chest pain.

BP 108-118 / 62-70. Pulse 84-96, irregularly irregular. SpO2 92-95% on 2 L NC. JVP 4 cm. Bibasal crackles reduced. Pitting oedema 1+ bilaterally. Weight down 2.4 kg since admission.

Decompensated heart failure — responding to diuresis. AF with rapid ventricular response stabilising. CKD stage 4 — creatinine stable.

Step down to oral furosemide 80 mg BD. Continue bisoprolol, ramipril at low dose. Monitor U&E daily. Warfarin — target INR 2-3. Plan discharge tomorrow if stable. Discuss goals of care with daughter.