This patient likely has cardiac tamponade, and the most important diagnostic study to perform next would be an echocardiogram, which will confirm the presence of an effusion and direct further management. Cardiac enzymes would help rule out an MI, and sputum stain for mycobacterium would help identify the etiology of acute pericarditis. However, it is more important to initially rule out or confirm the presence of an effusion causing cardiac tamponade. Computed tomography is a useful modality for imaging the pericardium, but it is not as cost-effective and cannot be obtained as quickly as an echocardiogram.
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