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Middle-aged Man With Exertional Dyspnea and Neck Fullness

A man in his mid-50s was referred with 2 years of insidious exertional dyspnea and neck fullness. Abdominal examination revealed an enlarged, pulsatile liver with smooth edges palpable 4 cm below the costal margin, and electrocardiography showed resting abnormalities (rightward axis and inferolateral T-wave inversions). What would you do next?

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