Cardiovascular Medicine Q 2

A 69-year-old man is evaluated in the hospital for four episodes of chest pain at rest in the past 24 hours. Medical history is significant for hyperlipidemia, hypertension, tobacco use, and previous transient ischemic attack. Medications are aspirin, hydrochlorothiazide, atorvastatin, and ramipril.

On physical examination, vital signs are normal. The remainder of the examination is unremarkable.

Laboratory studies are notable for normal serum troponin levels.

An electrocardiogram demonstrates 2-mm ST-segment depressions in leads V4 through V6.

Metoprolol, nitrates, clopidogrel, and heparin are initiated.

Which of the following is the most appropriate management?

A Adenosine nuclear stress testing

B Coronary CT angiography

C Exercise stress electrocardiography

D Urgent angiography

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