A 55-Year-Old Male on Statins Experiencing Sharp Chest Pain

Editor's Note: Based on To SPECT or Not to SPECT: Can Temporal Trends at a Single Center Inform Us?

A 55-year-old white man with a history of hypercholesterolemia on statin therapy with no personal history of diabetes or hypertension presents to cardiology clinic for evaluation for chest pain. Pain is described as a sharp pain on the right side of his chest. There is no radiation of the pain or associated symptoms of nausea, diaphoresis, or shortness of breath. Symptoms occur with and without exertion. He reports no difficulty climbing 1 flight of stairs in his home. He denies symptoms of orthopnea, paroxysmal nocturnal dyspnea, pedal edema, pre-syncope, syncope, or palpitations.

On examination, the patient is a well-appearing man with a blood pressure of 130/70 and a heart rate of 82 beats per minute. His cardiac examination is unremarkable and his lungs are clear. His most recent fasting lipid panel showed total cholesterol of 158mg/dL, LDL of 95mg/dL, HDL of 40mg/dL and TG of 115mg/dL.

His electrocardiogram is shown below:
Figure 1
Figure 1: A 55-Year-Old Male on Statins Experiencing Sharp Chest Pain

What is the next step for evaluation of this symptomatic patient?

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