Coronary artery disease Quiz: Ace Your Exams

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A 65-year-old woman presents to the emergency department for evaluation of chest pain. The patient reports left-sided chest discomfort while she was on her daily two-mile walk this morning. It resolved when the patient stopped walking. The patient describes the pain as a pressure-like sensation that lasted approximately 15 seconds. She currently has no chest pain. Past medical history includes hypertension for which the patient takes amlodipine. Temperature is 37°C (98.6°F), blood pressure is 120/71 mmHg, pulse is 89/min, respiratory rate is 14/min, and oxygen saturation is 99% on room air. BMI is 28. Physical examination is unremarkable. Initial laboratory results and electrocardiogram are shown below. Which of the following is the best next step in management?  


 Reproduced from: Wikipedia

 Laboratory value  Result  Reference 
 Complete Blood Count (CBC)  
 Hemoglobin  14 g/dL  13.5-17.5g/dL 
 White blood cell count (WBC)  7,500/mm3  4,500-11.000/mm3 
 Serum chemistry  
 Troponin  < .04 ng/mL   <0.04ng/mL 

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