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A 28 year-old woman with Eisenmenger VSD has been followed closely at an ACHD center and has been able to lead a normal lifestyle, working full time at a retail store. The last week she noted URI symptoms, and yesterday had an episode of diplopia that lasted for 15 minutes. She came in for an evaluation and had no neurological deficit. Her CBC showed a Hb of 19 g/dL with a HCT of 58%.

What is the next step in management?

  1. MRI scan of the head
  2. Phlebotomize two units blood emergently
  3. Echocardiogram with contrast injection
  4. Hospitalize for IV UFH

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