A 45-year old man presents to the emergency room complaining of breathing difficulty, palpitations, dizziness and chest pain for 15 minutes


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A 45-year old man presents to the emergency room complaining of breathing difficulty, palpitations, dizziness and chest pain for 15 minutes. He is a new employee at the hospital. He was waiting for a meeting when he experienced these symptoms. He had 3 similar episodes during the past 3 months but they resolved spontaneously. His medical and surgical histories are unremarkable. He has no family history of cardiac disease or sudden death. On examination, he is anxious, vital signs are within normal limits and heart and chest examinations are normal.
What is the next step of management for this patient?

A- Assurance and send him home for the rest of the day
B- 12-Lead ECG, random blood glucose and thyroid panel
C- Psychotherapy and alprazolam
D- Call cardiology department and prepare for PCI

The correct answer is B

Any case of chest pain in middle aged or old male patients is considered heart attack until proved otherwise. ECG is the next step and glucose and thyroid panel to exclude other causes of dizziness.