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A 63-Year-Old Man Comes to the Emergency Department Due to Chest

question 394

Multiple Choice

A 63-year-old man comes to the emergency department due to chest pain that occurred 2 hours ago when he was shopping for groceries. The patient experienced left-sided chest discomfort that was dull in nature and lasted 15 minutes. He had no shortness of breath, diaphoresis, palpitations, or lightheadedness. He has had no previous chest pain other than a similar episode 2 days ago when he was at home washing dishes. The pain at that time lasted 10 minutes and resolved spontaneously. The patient has hypertension and takes valsartan and amlodipine. Medical history also includes gout, peptic ulcer disease, kidney stones, and severe osteoarthritis of the right knee. He was offered knee replacement 2 years ago but refused. The patient walks with a cane. He has no known drug allergies. He is a lifetime nonsmoker. His father had a myocardial infarction at age 53 and his younger brother is healthy. The patient appears comfortable and has no complaints. Blood pressure is 147/90 mm Hg, and pulse is 82/min and regular. He has no heart murmurs or additional sounds. There are no carotid bruits. The lungs are clear on auscultation. There is no peripheral edema. ECG shows normal sinus rhythm without repolarization changes. Complete blood count and basic metabolic panel are unremarkable. Chest x-ray is normal. Two sets of cardiac troponin I drawn 4 hours apart are undetectable. Which of the following is the best next step in management of this patient?

Definitions:

Supermarket Redlining

A discriminatory practice where supermarkets or large grocery store chains avoid opening stores in economically disadvantaged or minority neighborhoods.

Corporations

Organizations or businesses recognized by law as a single entity, having rights and responsibilities, and authorized to act as a single person.

Low-Profit Areas

Regions or communities characterized by below-average income levels and economic activity, often facing higher instances of poverty and limited access to resources.

IRS Regulations

Rules and guidelines issued by the Internal Revenue Service governing federal tax administration in the United States.