Soru

A $68$-year-old woman is evaluated on postoperative day $3$ following an elective open sigmoid colectomy for recurrent diverticulitis. Over the past $2$ hours, she has developed significant shortness of breath, diaphoresis, and acute confusion. Her medical history is significant for hypertension, type $2$ diabetes mellitus, chronic obstructive pulmonary disease, and major depressive disorder. Her home medications, which were restarted postoperatively, include lisinopril, metformin, tiotropium, and citalopram. Temperature is $37.9^\circ$ C ($100.2^\circ$ F), blood pressure is $82/50$ mm Hg, pulse is $122$/min, and respirations are $28$/min. Pulse oximetry shows $88\%$ on room air. Physical examination reveals elevated jugular venous pressure and a new, harsh, holosystolic murmur heard best at the cardiac apex with radiation to the axilla. Lung auscultation demonstrates bilateral crackles extending up to the mid-lung fields. The abdomen is soft, mildly distended, and tender near the surgical incision, which is clean and intact. An electrocardiogram reveals sinus tachycardia with $2$-mm ST-segment depressions in leads II, III, and aVF. Which of the following is the most appropriate next step in management?