A 70-year-old man is brought to the emergency department with electrocardiogram changes indicating an acute myocardial infarction. He is given aspirin and tPA and started on a heparin drip. Vital signs are normal, and a beta-blocker, ACE inhibitor, and statin are also started. Ten hours after hospitalization, the patient becomes confused,drowsy, and complains of mild dyspnea. His blood pressure is now 65/50 mm Hg, heart rate is 120/min, and respiratory rate is 25/min. Pulse oximetry is 80% on room air. He is transferred to the intensive care unit,where he is intubated and begun on normal saline intravenous fluids. Electrocardiogram reveals sinus tachycardia with low voltage. A pulmonary artery catheter is placed, and the following readings are obtained;
Right atrial pressure 18 mm Hg (N = 2–10 mm Hg)
Right ventricular pressure 30/18 mm Hg (N =15–30/0–5 mm Hg)
Pulmonary capillary wedge pressure 17 mm Hg (N = 5–11 mm Hg)
Which of the following is the most appropriate next step in management?
A. Arrange for pericardiocentesis
B. Continue current treatment
C. Continue intravenous fluids
D. Start diuretics
E. Start dopamine
Right atrial pressure 18 mm Hg (N = 2–10 mm Hg)
Right ventricular pressure 30/18 mm Hg (N =15–30/0–5 mm Hg)
Pulmonary capillary wedge pressure 17 mm Hg (N = 5–11 mm Hg)
Which of the following is the most appropriate next step in management?
A. Arrange for pericardiocentesis
B. Continue current treatment
C. Continue intravenous fluids
D. Start diuretics
E. Start dopamine