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A 42-Year-Old Man Is Brought to the Emergency Department Due

question 901

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A 42-year-old man is brought to the emergency department due to 4 hours of chest tightness and shortness of breath.  He has not had similar symptoms before.  He returned to the United States from a business trip to Paris a week ago.  He thinks that his symptoms are due to an upper respiratory infection, which he suspects he contracted from recirculated air on the plane.  The patient takes no medications and does not use alcohol or illicit drugs.  He has a 20-pack-year smoking history.  Blood pressure is 152/99 mm Hg and pulse is 92/min.  BMI is 32 kg/m2.  ECG is shown in the exhibit.  A 42-year-old man is brought to the emergency department due to 4 hours of chest tightness and shortness of breath.  He has not had similar symptoms before.  He returned to the United States from a business trip to Paris a week ago.  He thinks that his symptoms are due to an upper respiratory infection, which he suspects he contracted from recirculated air on the plane.  The patient takes no medications and does not use alcohol or illicit drugs.  He has a 20-pack-year smoking history.  Blood pressure is 152/99 mm Hg and pulse is 92/min.  BMI is 32 kg/m<sup>2</sup>.  ECG is shown in the exhibit.   Which of the following is the most appropriate next step in management of this patient? A) Cardiac enzymes and serial ECGs B) CT angiography of the chest C) Exercise ECG stress testing D) Nonsteroidal anti-inflammatory agents and colchicine E) Percutaneous coronary interventionWhich of the following is the most appropriate next step in management of this patient?

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