WJ
is a 62 year old AA female with hypertension, Type II insulin-requiring
diabetes mellitus, hyperlipidemia and chronic renal insufficiency. The
patient was admitted to the ED with a 12 hour complaint of new onset
intermittent rest and nocturnal angina. Her BP is 150/90 mm Hg, pulse
is regular at 80/min and respirations are unlabored at 20/min. There
is an S4 gallop at the apex. Lungs are clear, abdomen is unremarkable
and there is no pitting edema.
The serum BUN/Cr are 36/2.4 mg/dl, while the remainder of the BMP is
WNL. CBC is unremarkable and cardiac enzymes are negative. Chest x-ray
shows an uncoiled aorta and no acute abnormality.
Her EKG demonstrated a sinus mechanism with 2 mm ST depression in the
inferior and lateral leads.:
Which of the following is not indicated in the management of this patient?