10th May 2025

You are asked to urgently review a patient on the cardiology ward.

You are asked to urgently review a patient on the cardiology ward. The patient is a 37-year-old female  who has just moved 3 months ago from Somalia, and is experiencing malaise, fatigue and a reduced  exercise tolerance for the last month. She has a past-medical history of childhood asthma, 5 months ago  treated for TB, and insulin dependent type 1 diabetes, pAF controlled by bisoprolol, and is  anticoagulated with apixaban. She has a respiratory rate of 22/min, has oxygen saturations of 93% on  room air, a heart rate of 105bpm, blood pressure of 82/59, and is afebrile. AVPU score is V.  

On review, you can see that there is Kussmaul’s sign present with prominent X and Y descents, moderate  peripheral oedema, and pulsus paradoxus. Her recent blood tests show worsened renal and hepatic  function but improving inflammatory markers. She is currently being treated with diuretics and anti-inflammatory agents of which she has been taking for 2 months now. An ECG is done and shows sinus tachycardia with low voltage QRS complexes.

What is the best step in her definitive management?  

Select the SINGLE most appropriate option from the list below. Select ONE option only.