A 72-year-old woman is brought to the Emergency Department by her daughter because of significant functional decline and progressive shortness of breath. She has widespread metastatic breast cancer and recently stopped chemotherapy due to progression and intolerance. She has been bedridden for 4 weeks. On examination:
BP: 100/70 mm Hg with pulsus paradoxus of 20 mm Hg
HR: 99/min
Temp: 36.5°C
SpO₂: 94% room air
JVP: elevated
Heart sounds: muffled
Chest X-ray: large globular heart
Labs:
Hemoglobin: 90 g/L
Sodium: 118 mmol/L
Creatinine: 94 µmol/L
Which one of the following is the best next step?
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