Review Question - QID 109376

A 52-year-old man presents to the emergency department with progressive leg swelling and chest pain. He noticed the leg swelling about 2 months ago. The chest discomfort began with a sternal “ache” yesterday that has continued to worsen. He took an antacid but he noticed no improvement of his symptoms. The patient has a history of end stage renal disease and hyperlipidemia. His current medications include furosemide, atenolol, and simvastatin. His temperature is 97°F (36.1°C), blood pressure is 110/62 mmHg with no changes upon inspiration, pulse is 88/min, and respirations are 16/min with an oxygen saturation of 97% O2 on room air. The patient appears anxious and is sitting bent over, which he reports is helping to alleviate some of the chest pain. He has jugular venous distension during both inspiration and expiration and 2+ bilateral lower extremity edema. The patient's ECG is within normal limits. Labs are obtained with the results shown below:

Serum:
Na+: 140 mEq/L
Cl-: 98 mEq/L
K+: 4.6 mEq/L
HCO3-: 16 mEq/L
Urea nitrogen: 75 mg/dL
Glucose: 100 mg/dL
Creatinine: 6.0 mg/dL

Leukocyte count: 12,000/mm^3
Segmented neutrophils: 60%
Bands: 3%
Eosinophils: 3%
Basophils: < 1%
Lymphocytes: 28%
Monocytes: 5%
Hemoglobin: 13.0 g/dL
Hematocrit: 50%
Platelets: 170,000/mm^3

The patient’s chest radiograph is shown in Figure A. Which of the following is the most appropriate next step in management?