Last updated on:May 12th, 2022
You’re looking at a multiple-choice question from QBank Prepper (the newest of four distinct learning formats available in Clinical Odyssey). Try it out, and have fun improving your clinical skills.
A 66-year-old woman comes to the physician's office with a 4-month history of progressive fatigue. She reports difficulty in breathing after walking more than four blocks, that improves with rest. She denies fever, weight loss, or chest pain. She was diagnosed with adenocarcinoma of the left breast 12 years ago and received chest radiotherapy. Her pulse is 75/min, respirations are 16/min, and blood pressure is 90/60 mm Hg. Jugular venous distension, muffled heart sounds, diffuse apical impulse, and ascites are present. Echocardiography shows normal systolic function, increased respiratory septal motion with ventricular interdependence, a beat-to-beat “shudder”, pericardial thickening, and a dilated inferior vena cava. Central venous catheterization shows elevated diastolic pressure.
Which of the following is the most appropriate next step in the management of this patient?