A 32-year-old woman comes to the emergency department due to sudden-onset left-sided facial droop and arm weakness. The patient also has had right leg swelling after a recent road trip. She has no chronic medical conditions, and her only medication is an oral contraceptive. CT scan of the head shows a right middle cerebral artery territory acute infarction. Lower extremity ultrasound examination reveals a right femoral vein thrombus. No obvious cardiac structural abnormalities are detected on an echocardiogram. Agitated normal saline is injected into a peripheral vein to evaluate for abnormal right-to-left shunting. No bubbles are seen in the left side of the heart after several minutes. Which of the following is most appropriate to increase right-sided heart pressure to reveal an obscure intracardiac shunt?

Question

A 32-year-old woman comes to the emergency department due to sudden-onset left-sided facial droop and arm weakness.  The patient also has had right leg swelling after a recent road trip.  She has no chronic medical conditions, and her only medication is an oral contraceptive.  CT scan of the head shows a right middle cerebral artery territory acute infarction.  Lower extremity ultrasound examination reveals a right femoral vein thrombus.  No obvious cardiac structural abnormalities are detected on an echocardiogram.  Agitated normal saline is injected into a peripheral vein to evaluate for abnormal right-to-left shunting.  No bubbles are seen in the left side of the heart after several minutes.  Which of the following is most appropriate to increase right-sided heart pressure to reveal an obscure intracardiac shunt?

Quizplus · Accepted Answer

The Answer is E

A 32-Year-Old Woman Comes to the Emergency Department Due to Sudden-Onset