Soru

A $64$-year-old woman is brought to the triage desk by her family due to extreme lightheadedness and a progressive inability to catch her breath over the past three days. She has a medical history significant for severe rheumatoid arthritis and chronic obstructive pulmonary disease. Two weeks ago, she experienced a self-limiting febrile viral illness. On examination, the patient appears visibly distressed and diaphoretic. Vital signs show a temperature of $37.1^\circ\text{C}$ ($98.8^\circ\text{F}$), heart rate of $118\text{/min}$, respiratory rate of $24\text{/min}$, and blood pressure of $86/60\text{ mmHg}$. During normal inspiration, her systolic blood pressure decreases by $18\text{ mmHg}$. Jugular venous distention is prominent up to the angle of the mandible while she sits upright. Pulmonary auscultation reveals globally distant breath sounds but no crackles or active wheezing. Cardiac auscultation is limited by an increased anterior-posterior chest diameter, and no murmurs are appreciated. An electrocardiogram demonstrates a regular tachycardia with low-voltage QRS complexes in the limb leads and shifting electrical axes. Which of the following is the most appropriate next step in management?