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Old 07-22-2015
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Default Remembered USMLE Question 204

A 36 year-old man presents to the emergency room with a complaint of severe chest pain, difficulty in breathing and dry cough. He is anxious because his father died of a heart attack in his forties. He is an athlete, never smokes, never drinks alcohol or takes any recreational drugs. His chest pain is sharp stabbing and localized in the middle of his chest and the back of his shoulders. His pain started two days ago but he didn't pay attention because he has common cold since last week. His shortness of breath started last night and awaken him and he had to get up and lean forward so he could breathe. His vital signs are within normal limits. On examination, there is no tenderness, some crackles on his lungs and normal heart sounds. His ECG is shown on the image.
What is the most appropriate next step for this patient?
A- Chest x-ray
B- Stress test
C- Echocardiography
D- Refer him to cardiology department
E- Give him lorazepam and send him home
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