A 27-Year-Old Man Is Brought to the Emergency Department Due

question 3

Multiple Choice

A 27-year-old man is brought to the emergency department due to a syncopal episode.  He passed out while unloading heavy packages from his truck during a hot summer day.  According to a witness, the episode lasted 30 seconds, and he regained consciousness quickly.  The patient has had no chest pain or palpitations.  Over the past year, he has had brief episodes of lightheadedness related to intense exercise.  Medical history is otherwise insignificant.  He works for a landscaping company.  Blood pressure is 130/75 mm Hg while supine and 125/75 mm Hg while standing and pulse is 78/min and regular.  Oxygen saturation is 98% on room air.  On examination, the patient has no murmur.  The lungs are clear to auscultation.  ECG shows T-wave inversion in leads V₄-V₆.  Complete blood count, serum electrolytes, and cardiac enzymes are within normal limits.  Which of the following is the most appropriate next step in management?

• A)Ambulatory ECG monitoring
• B)Echocardiography
• C)Coronary angiography
• D)CT pulmonary angiography
• E)Reassurance and routine follow-up

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Definitions:

Self-Disclosure

The act of revealing personal information to others, which can foster intimacy and trust in relationships.

Gut Level

Referring to instinctive, immediate reactions or feelings, devoid of rational analysis.

Work Environments

The physical and psychological conditions under which employees perform their job duties, including culture, physical space, and social aspects.

Productivity

The rate at which goods or services are produced, especially in relation to the input of labor, materials, etc.