MEDizzy - You are caring for a 38-year-old male patient who reports

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Acute Complaints

You are caring for a 38-year-old male patient who reports episodic chest pain. He reports that the pain feels like “tightness,” is located right behind his sternum, lasts less than 3 minutes, and is relieved with rest. He takes no medications, has no family history of coronary disease, and has never smoked. His ECG in the office is normal. Which of the following tests should be done to determine whether or not his chest pain is due to ischemia?

ExplanationBased on the patient’s symptoms, angina seems to be a likely diagnosis. Exercise ECG testing is the most commonly used noninvasive procedure for evaluating whether the chest pain is due to angina. Stress testing is often combined with imaging studies, but in low-risk patients without baseline ECG abnormalities, exercise ECG remains the recommended initial procedure because of its low cost and convenience. Myocardial stress imaging (scintigraphy or echocardiography) is indicated if the resting ECG makes an exercise ECG difficult to interpret, for confirmation of the results of the exercise ECG, to localize the region of ischemia, to distinguish ischemic from infarcted myocardium, or to assess the completeness of revascularization following an intervention. The electron beam CT can quantify coronary artery calcification, but is not helpful to evaluate angina.