A 75-Year-Old Man Comes to the Emergency Department with 6

question 96

Multiple Choice

A 75-year-old man comes to the emergency department with 6 hours of intermittent chest pain.  He has no nausea, vomiting, syncope, shortness of breath, or diaphoresis.  His medical problems include type 2 diabetes mellitus, hypertension, and hyperlipidemia.
The patient's blood pressure is 142/78 mm Hg and pulse is 82/min.  Cardiac and pulmonary examinations are within normal limits.
Electrocardiogram shows normal sinus rhythm with 1.5-mm horizontal ST-segment depression in leads II, III, and aVF.  Initial troponin I level is 2.2 ng/mL (normal <0.012 ng/mL) .
The patient receives antiplatelet agents, nitroglycerin, and anticoagulation.  He reports complete resolution of symptoms.
Which of the following is the best next step in management of this patient?

• A)Cardiac catheterization within 90 minutes
• B)Cardiac catheterization within 24 hours
• C)Coronary calcium score
• D)Medical therapy and discharge if no recurrence of chest pain
• E)Medical therapy and stress test before discharge

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