A frail woman in her 90s with chronic systolic heart failure, nonischemic cardiomyopathy, atrial fibrillation with left bundle branch block (LBBB), stage 3 chronic kidney disease, history of bladder cancer, and multiple mechanical falls within the past year presented to our hospital with a 5-day history of progressive dyspnea and resting chest pain. During the past 4 years, her heart failure had been managed with stable doses of metoprolol succinate, lisinopril, and furosemide. Physical examination revealed diffuse crackling in the lungs bilaterally.