CHEST PAIN

Q. A 56-year-old man comes to the office a few days after an episode of chest pain.

This was his first episode of pain, and he has no risk factors. In the emergency

department, he had a normal EKG and normal CK-MB and was released the next

day. Which of the following is most appropriate in his further management?

a. Repeat CK-MB

b. Statin

c. LDL level

d. Stress (exercise tolerance) testing

e. Angiography

Answer: D.

Stress test when the case is equivocal or uncertain for the presence of CAD. Do not do an angiography unless the stress test is abnormal. Exercise tolerance, or “stress,” testing detects coronary artery disease when the heart rate is raised and ST segment depression is detected. This case is asking you to know that a stress test is a way of increasing the sensitivity of detection of CAD beyond an EKG and enzymes.