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USMLE Step 3 Review
A
62 year old male
with a history of hypertension, diabetes, rheumatoid arthritis and
prior mechanical aortic valve replacement, presents to the emergency
department with fevers for 3 days. He denies any chest pains or
shortness of breath. His medications include
lisinopril, hydrochlorothiazide, aspirin, and coumadin. His temperature
is 38.4 C, blood pressure is 160/60, heart rate 100, respirations 20,
and oxygen saturation 99% on room air. Physical examination reveals
normal lung sounds, a II/IV early diastolic decrescendo murmur at the
left lower sternal border, and a
very soft S1 heart sound. Laboratory studies reveal a white
blood cell count of 15 thousand and an ESR of 110. A portion of his ECG
is below. Which of the following is the most approtriate test to obtain
at this time?
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