July 26th, 2020
A 54-year-old woman with end-stage renal disease comes to the physician with fatigue and shortness of breath on exertion for three days. She missed her routine hemodialysis sessions; the last was two weeks ago. Her pulse is 98/min, blood pressure is 140/70 mmHg, and respirations are 16/min. The lungs are clear to auscultation. Heart sounds are muffled. An ECG shows low voltage QRS complexes in all leads. An x-ray of the chest reveals cardiomegaly. Which of the following is the most appropriate next step in management?