Correct!
3. Begin intravenous epoporostenol therapy
The patient’s right heart catheterization results suggest group I pulmonary arterial hypertension, for which prostacyclin therapy is appropriate. Anti-dysrhythmic agents are not indicated, nor is therapy directed at decreasing heart rate and left ventricular afterload or for augmenting left ventricular contractility.
The biopsy of the lower extremity rash showed fat necrosis, thought to be the result of trauma, and some eosinophilia, but no organisms were identified and no features diagnostic of a particular condition were seen. Tadalafil was added to the patient’s pulmonary hypertension regimen. The patient began to improve, with no fever development and decreasing oxygen requirements, eventually oxygenating well on room air. Repeat transthoracic echocardiogram showed decrease in the right ventricular systolic pressure from 88 mmHg to 66 mmHg. Subsequently, the patient underwent transesophageal echocardiography which showed normal left ventricular systolic function. Her right ventricular systolic pressure was 62 mmHg. No masses, thrombus, or vegetation on the valves were noted. A patent foramen ovale was noted.
At this point, which of the following represents the most appropriate step in this patient’s management? (Click on the correct answer to proceed to the twelth and final page)