USMLE Step 3 - Question 2

A 58 year old male with a history of diabetes, hypertension, and a renal transplant presents to the emergency department after being found unresponsive at home. His temperature is 37.3 C, blood pressure is 70/30, heart rate 120, respirations 24, and oxygen saturation 70% on room air. Physical examination reveals bilateral pulmonary rales, a S4 heart sound is present, and no murmurs could be auscultated. He is intubated for airway protection. ECG reveals sinus tachycardia with a left bundle branch block. A Swan-Ganz catheter is inserted and the values are below:

Right atrial presssure - 8 mmHg
Right ventricular pressure - 38/8 mmHg
Pulmonary artery pressure - 42/22 mmHg
Pulmonary capillary wedge pressure - 26 mmHg
Cardiac output - 4.0 L/min
Cardiac index - 2.0 L/min/BSA

Which of the following is best course of action?

A. Tissue plasminogen activator infusion (tPA)

B. Emergent cardiac catheterization

C. Echocardiography

D. Glycoprotein IIb/IIIa infusion

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