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A 74-Year-Old Man with Type 2 Diabetes Is Admitted to the Cardiac

question 128

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A 74-year-old man with type 2 diabetes is admitted to the cardiac care unit after an episode of substernal chest pain. He has no history of coronary artery disease. He was hospitalized two years ago for lower gastrointestinal bleeding and one year ago for community-acquired pneumonia. He has non-specific ECG changes, and his initial troponin I level is 1.3 ng/mL. Cardiac catheterization is performed showing 95% proximal left anterior descending artery stenosis and 85% proximal right coronary artery stenosis. No intervention is performed and coronary artery bypass surgery is planned for the following day.
Five hours after the catheterization procedure, the patient complains of generalized weakness and back pain. He appears to be diaphoretic and clammy. His blood pressure is 77/55 mm Hg and pulse is 122/min and regular. His neck veins are flat. Heart sounds are normal and the chest is clear to auscultation. The site of arterial puncture at his groin is mildly tender without subcutaneous hematoma. He receives 1 liter of normal saline with symptomatic improvement. Repeat blood pressure is 92/60 mm Hg and pulse is 96/min. His ECG is unchanged from the previous one.
Which of the following is the best next step in managing this patient?

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