The CBC count showed a hematocrit of 32.5% and leukocytosis with left shift (13,400 cells/μL with 90% neutrophils); the findings of coagulation studies were notable for an international normalized ratio of 1.94. Blood chemistry analysis showed a BUN concentration of 110 mg/dL, a creatinine level of 4.2 mg/dL, a creatine phosphokinase concentration of 334 U/L, and a troponin I level of 0.83 ng/mL (normal concentration, < 0.1 ng/mL). An arterial blood gas measurement showed a Pao2 of 66 mm Hg, and combined metabolic and respiratory acidosis (Paco2, 75 mm Hg; Hco3, 16 mmol/L; pH, 7.05). The chest radiogram demonstrated bilateral alveolar infiltrates, and the ECG revealed sinus tachycardia, right-axis deviation, and diffuse repolarization abnormalities. An emergent transthoracic echocardiogram (TTE) showed a dilated right ventricle, paradoxical movement of the intraventricular septum, and a small left ventricle with normal systolic function. The prosthetic valve could not be assessed.