Approach to chest pain Quiz: Ace Your Exams

A 33-year-old woman presents to the emergency department for evaluation of chest pain. The patient states the pain feels sharp, but she does not note any exacerbating or relieving factors. The patient says she has eaten several spicy meals recently and wonders if the pain is related to indigestion. The patient reports she recently began a new exercise regimen involving arm and chest strengthening exercises. The patient is otherwise healthy and takes an oral contraceptive pill daily. Temperature is 37.0°C (98.6°F), pulse is 103/min, respirations are 16/min, blood pressure is 120/65 mmHg, and oxygen saturation is 96% on room air. Physical examination shows a young, healthy woman in no acute distress. The cardiopulmonary examination is normal. There is some reproducible pain with palpation over the costal cartilage. ECG demonstrates sinus tachycardia, and chest radiography is unremarkable. Initial troponin is <.05 ng/L. Which of the following is the next best step in management?