Approach to postoperative hypotension Quiz: Ace Your Exams

A 62-year-old man is evaluated in the hospital for low blood pressure several hours after an open cholecystectomy. The patient describes mid-sternal chest pressure and significant shortness of breath. His past medical history is significant for diabetes mellitus, dyslipidemia, hypertension, and daily tobacco use. An outpatient transthoracic echocardiogram performed six months ago was normal. Current medications include amlodipine, clonidine, metformin, and pravastatin. Temperature is 36.5 ºC (97.7 ºF), pulse is 108/min, respiratory rate is 22/min, blood pressure is 81/40 mmHg, and SpO₂ is 94% on room air. On physical examination, the patient is ill-appearing. There is no significant jugular venous distention. The chest pressure is not reproducible with palpation. Cardiac sounds are audible, and there are faint bibasilar crackles on lung auscultation. An ECG demonstrates a new left bundle branch block. Bedside transthoracic echocardiogram shows a small pericardial effusion, severe anterior and septal hypokinesis, and a dilated left ventricle with reduced ejection fraction. Laboratory studies are pending. Which of the following is the best next step in management?