Chest Pain – A Halting Presentation

A 55-year-old woman with a past medical history of hypertension presents to the emergency room with progressive chest pain for the past week, worse with exertion, leading up to the day of presentation. Vitals on presentation are notable for temperature 37.3 C, heart rate 108, blood pressure 110/82, SpO2 98% on room air. On examination her lungs are clear, regular rate and rhythm with no murmurs, abdomen is soft, 1+ pitting edema of the lower extremity. Labs are notable for a high-sensitivity troponin elevation on presentation to 250 pg/mL, increasing slightly to 300 pg/mL on recheck (assume reference range 0 – 20 pg/mL for this assay). The patient's electrocardiogram exhibits diffuse ST depressions. She is given aspirin 325 mg and nitroglycerin without resolution of chest pain. She is taken for coronary angiography which shows nonobstructive coronary artery. The patient is admitted for further work-up.

Which test or procedure is the most appropriate to pursue next in the diagnosis of this patient's care?

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