Case: Left-sided Chest Pain von Charles Vega, MD

A previously healthy 42-year-old gardener presents to your clinic for a six-week history of left-sided chest pain that comes and goes. The pain is sharp and usually occurs when he bends over to pick something up in the garden. Episodes last a few seconds. He points to the pain with his two fingers just between the 4th and 5th ribs on the left side. He denies shortness of breath or nausea during pain. He has no personal or family history of a serious illness. He does not take any medications or smoke. Physical examination shows no abnormalities other than tenderness over the location of the pain. An electrocardiogram shows no abnormal findings. Which of the following is the most appropriate next step in the diagnosis or management of this patient?

A previously healthy 28-year-old woman presents to your office because of substernal chest pain that comes and goes. It usually occurs in the evenings after dinner when she lays down to rest. The pain is deep and burning in quality and lasts several hours. In the mornings, she often has a dry cough and a metallic taste in her mouth but does not particularly feel short of breath. She has no symptoms during her regular exercise. The patient is not on any medications or smokes. Physical examination shows no abnormal findings, and an ECG shows no abnormalities. Which of the following is the most appropriate next step in management?

A 56-year-old man comes to your office because of one-week history of several episodes of left-sided chest pain. The pain is accompanied by shortness of breath and occurs when he climbs the stairs or walks fast, but it is relieved after about 5 minutes of rest. He has a history of poorly controlled diabetes, hyperlipidemia, and hypertension. He has smoked one pack of cigarettes daily for 30 years. His vital signs are within normal limits. Cardiopulmonary examination shows no abnormal findings. An ECG shows an old left bundle branch block, also present on a previous ECG obtained one year ago. Which of the following is the most appropriate next step in management?