Solved

A 48-Year-Old Woman Comes to the Emergency Department Due to "Fluttering

question 375

Multiple Choice

A 48-year-old woman comes to the emergency department due to "fluttering" in her chest and 10/10 nonradiating chest pain. She feels as if "someone is sitting on my chest." The patient has had similar episodes during the past 6 months that occur at rest and with exertion. In addition to the chest pain, she experiences dyspnea, dizziness, paresthesias, and abdominal cramping. She has also noticed that she fears and avoids being in public places such as crowded shopping malls and restaurants. The patient now insists that her husband drive her to work due to fear of having an attack while driving alone. Over the past month, she has left work on multiple occasions due to the episodes and worries that she will have to stop working or be fired for repeated absences. The patient is an administrative assistant with an approximately 20-year smoking history. She does not use other substances and her medical history is insignificant. She is postmenopausal. Her father and paternal uncle suffered myocardial infarctions in their 50s.
Temperature is 37.2 C (99 F) , blood pressure is 130/80 mm Hg, pulse is 94/min, and respirations are 18/min. The patient is a well-developed woman who appears her stated age. She is anxious and diaphoretic. Physical examination is otherwise normal.
ECG shows no evidence of an ischemic event. Laboratory studies, including complete blood count, chemistries, liver function, and urinalysis, are within normal limits. The patient has negative serial troponin and CK-MB levels.
Which of the following is the most appropriate pharmacotherapy for this patient's symptoms?

Definitions:

Social Relationships

Connections and interactions between individuals or groups, influencing and contributing to social structures and dynamics.

Situational Factors

External conditions or events that influence the effectiveness of leadership and management practices.

Trait

A distinguishing quality or characteristic, typically one belonging to a person, often considered in the context of leadership to identify specific attributes associated with effective leaders.

Trait Approach

A perspective in leadership theory that focuses on identifying the specific personality traits and abilities that make a successful leader.