A 57-year-old man experiences chest pain with exertion radiating to the left shoulder; which initial tests are appropriate?

A 57-year-old man experiences chest pain with exertion radiating to the left shoulder; which initial tests are appropriate?

• A. Coronary angiography and chest X-ray
• B. EKG and exercise treadmill test
• C. Echocardiography alone
• D. Serum troponin alone

Answer: (B)

The main concept is evaluating exertional chest pain for possible ischemia with simple, noninvasive tests first. An undemanding resting ECG can reveal prior heart damage or baseline abnormalities, and an exercise treadmill test assesses how the heart responds to stress to detect inducible ischemia and gauge functional capacity. This combination is the appropriate starting step because it provides functional and electrical information without being invasive. Coronary angiography is invasive and reserved for cases with high-risk features or positive noninvasive testing, not initial evaluation. A chest X-ray on its own doesn’t address ischemia. Echocardiography is useful for structural or wall-motion assessment, but without a stress component it doesn’t reliably reveal exercise-induced ischemia. Serum troponin is essential when ruling in or out acute myocardial injury, but this scenario describes exertional chest pain without current myocardial infarction, so troponin alone isn’t the best first test.

The main concept is evaluating exertional chest pain for possible ischemia with simple, noninvasive tests first. An undemanding resting ECG can reveal prior heart damage or baseline abnormalities, and an exercise treadmill test assesses how the heart responds to stress to detect inducible ischemia and gauge functional capacity. This combination is the appropriate starting step because it provides functional and electrical information without being invasive.

Coronary angiography is invasive and reserved for cases with high-risk features or positive noninvasive testing, not initial evaluation. A chest X-ray on its own doesn’t address ischemia. Echocardiography is useful for structural or wall-motion assessment, but without a stress component it doesn’t reliably reveal exercise-induced ischemia. Serum troponin is essential when ruling in or out acute myocardial injury, but this scenario describes exertional chest pain without current myocardial infarction, so troponin alone isn’t the best first test.