Which Diagnostic Test Would You Choose For This 59-Year-Old Male with Continuous Chest Pain?

HPI: The patient is a 59-year-old male with the onset of continuous chest pain 2 hours prior to admission. The pain was described as severe mid-sternal pain (unable to characterize further) without radiation, with associated dyspnea, diaphoresis, and nausea. He never had similar pain before.

PMH: Hypertension and Diabetes

MEDS: ACE inhibitor, Diuretic, Insulin

PE: BP Right arm 160/90 mmHg, Left arm 155/88 mmHg, pulse-110 bpm, RR 18, O2 sat 96% on 2 L NC
Gen; appears uncomfortable and in moderate distress
Heart: tachycardic without murmur or gallop, JVP-nl
Lungs: bibasilar crackles
Extremities: no edema, all peripheral pulses normal
ECG: sinus tachycardia with LVH with ST-T changes
CXR: mild interstitial markings c/w possible early CHF
Laboratory data:

cTnI- 0.09 ng/ml (99th% 0.04 ng/ml)
BNP- 250 pg/ml ( normal < 100 pg/ml)
D-dimer- 2,241 ng/mL ( normal < 500 ng/ml)
Electrolytes and CBC are normal

The patient received ASA, beta-blocker, and IV morphine. Repeat TnI 3 hours later was 0.10 ng/ml

What would you choose for the next diagnostic test?

Show Answer