Case of the Anomalous Origin of Chest Pain

A 47-year-old female registered nurse with a family history of coronary artery disease presented with atypical chest pain and palpitations. The patient stated that she had been having chest pain that was sharp in nature, radiating to her left arm, not associated with exertion, and not associated with shortness of breath. Vitals and physical exam were grossly normal. She underwent a treadmill stress test during which she was able to exercise for 13.4 MET and achieved 98% of her maximal predicted heart rate. She had no symptoms, and the electrocardiogram tracings did not show any ischemic changes. The patient also had a Holter monitor as well as a Zio Patch, which revealed rare premature atrial contractions. Echocardiography was performed, which revealed normal biventricular ejection fraction, normal biatrial size, and no hemodynamically significant valvular heart disease. Abnormality visualized on the parasternal short axis view. The patient was then recommended to have a cardiac computed tomography angiography (CTA).

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At this time, what would be the next course of action?

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