Soru

An emergency response team evaluates a $68$-year-old female who awoke abruptly with severe respiratory distress. Her medical history is notable for long-standing essential hypertension, obesity, diet-controlled type 2 diabetes mellitus, and a $35$-pack-year smoking habit.

Upon arrival at the emergency department, she appears highly anxious, diaphoretic, and is utilizing accessory muscles of respiration. Vital signs exhibit a blood pressure of $165/85 \text{ mmHg}$, a heart rate of $96 \text{ bpm}$, a respiratory rate of $28 \text{ breaths/min}$, and an oxygen saturation of $86\%$ on ambient air.

Auscultation of the lungs reveals a prolonged expiratory phase accompanied by high-pitched, diffuse bilateral wheezes. A faint $2/6$ systolic murmur is auscultated at the left lower sternal border.

The evaluating physician suspects an acute exacerbation of chronic obstructive pulmonary disease and immediately orders continuous nebulized albuterol along with intravenous methylprednisolone.

Twenty minutes after initiating therapy, the patient's condition deteriorates precipitously. She reports new-onset severe dizziness and retrosternal chest pressure.
Repeat vital signs indicate a blood pressure of $78/42 \text{ mmHg}$ and a heart rate of $128 \text{ bpm}$.
Repeat cardiac auscultation demonstrates that the previously faint murmur is now a prominent $4/6$ harsh, crescendo-decrescendo systolic murmur at the left lower sternal border.

A $12$-lead electrocardiogram demonstrates sinus tachycardia, voltage criteria for left ventricular hypertrophy, and deep, narrow Q waves in leads I, aVL, $V_5$, and $V_6$, with no ST-segment elevations.

Which of the following is the most appropriate next step in managing this patient's acute hemodynamic collapse?