Pre-Syncopal Episode in a Healthy Individual
A 52-year-old female patient with a history of seizures and hypertension presents to urgent care with a pre-syncopal episode of dizziness and hypotension. She has no history of dizziness unrelated to seizures. This episode occurred at work with no heavy lifting or new activity. She does not report chest pain, shortness of breath, nausea, fever, chills or vomiting. The patient reports a recent cold that is getting better. She has no surgical history. An electrocardiogram, troponin levels, and chest X-ray are all normal. She underwent computed tomography (CT) imaging with contrast pulmonary embolism (PE) protocol at the urgent care facility that was negative for PE, but what was found in Figure 1 prompted transfer to a tertiary center. On your exam in the emergency room, you confirm the patient's story. On physical exam, the only abnormality you note is on auscultation of the heart, where you find a 4/6 mid diastolic blowing murmur in the aortic foci and apex that radiates to the axilla.
Which of the following is the best way to proceed with this patient?