A 78-Year-Old Man Is Brought to the Emergency Department with Severe

A 78-year-old man is brought to the emergency department with severe abdominal pain over the last 6 hours.  He has vomited twice since the onset of symptoms.  Six months ago, he was diagnosed with severe aortic stenosis with an estimated aortic valve area of 0.8 cm² and has been followed clinically.  The patient's left ventricular ejection fraction was normal.  He also has chronic kidney disease with baseline estimated glomerular filtration rate of 50 mL/min.
His temperature is 38.3 C (101 F) , blood pressure is 102/65 mm Hg, and pulse is 122/min and regular.  Lungs are clear on auscultation.  A 3/6 mid-systolic murmur is heard at the right upper sternal border with radiation to the carotids.  The carotid pulse is delayed.  The abdomen is mildly distended and diffusely tender with prominent rebound tenderness.  The extremities are warm.  Upright chest x-ray shows free air under the diaphragm.
He receives intravenous fluids and antibiotics.
Which of the following is the best initial management for this patient?

A) Abdominal surgery with invasive hemodynamic monitoring
B) Aortic balloon valvuloplasty
C) Dobutamine echocardiography
D) Left heart catheterization
E) Pain control and supportive care