A 63-Year-Old Hospitalized Woman Develops Severe Shortness of Breath That

A 63-year-old hospitalized woman develops severe shortness of breath that awakens her from sleep.  She underwent elective right hip replacement for severe osteoarthritis 5 days ago.  She has no history of coronary artery disease.  She has received enoxaparin subcutaneously for deep vein thrombosis prophylaxis.
Her blood pressure is 78/50 mm Hg, pulse is 130/min, respirations are 34/min, and oxygen saturation is 70% on room air.  Jugular venous distension is present.  Her lungs are clear to auscultation.  There are no murmurs.  Her extremities are cold and clammy.
A 12-lead ECG shows sinus tachycardia.  Portable chest x-ray is ordered and preparations are made for endotracheal intubation.
Which of the following is the most appropriate next step in management?

A) Cardiac enzymes and D-dimer levels
B) CT angiogram of the chest
C) Emergent bedside transthoracic echocardiogram
D) Right heart catheterization
E) Ventilation/perfusion (V/Q) scan

Correct Answer:

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