Review Question - QID 109383

A 2-month-old girl presents to the emergency department for difficulty feeding. The patient was born at 38 weeks gestation to a 29-year-old primigravid mother via vaginal delivery. The newborn period has thus far been uncomplicated. The patient has been exclusively breastfed since birth. Feeding had previously seemed to be going well and the patient has been gaining weight appropriately. Over the past 3 days, the patient’s mother has noticed that the patient seems to tire out before the end of the feeding. The patient begins to appear short of breath and has a bluish discoloration of her lips. The patient’s height and weight were in the 20th and 10th percentile at birth, respectively. Her current height and weight are in the 20th and 15th percentiles, respectively. Her temperature is 98.0°F (36.7°C), blood pressure is 60/48 mmHg, pulse is 143/min, and respirations are 40/min. On physical exam, the patient is in no acute distress and appears well-developed. A systolic crescendo-decrescendo murmur can be heard at the left upper sternal border. Her abdomen is soft, non-tender, and non-distended. During the abdominal exam, the patient begins crying and develops cyanosis of the perioral region. Which of the following is the most appropriate test to diagnose this patient’s condition?