A 55-year-old man is evaluated for chest discomfort of several months' duration. He describes the pain as sporadic left-sided chest heaviness that lasts for several minutes. His chest discomfort is generally but not consistently induced by exercise and is often but not always relieved with rest. He has some associated shortness of breath but no other symptoms. He remains active despite the pain and is able to walk without limitations. Medical history is significant for hypertension treated with amlodipine and hydrochlorothiazide.

On physical examination, vital signs and the remainder of the physical examination are normal.

An electrocardiogram is shown.

Which of the following is the most appropriate management?

A 48-year-old man is evaluated for a 6-month history of intermittent palpitations with accompanying lightheadedness and near-syncope. The episodes last approximately 5 minutes and occur once or twice per week. He cannot identify any precipitating triggers for his symptoms. Medical history is notable for hypertension. His only medication is chlorthalidone.

On physical examination, vital signs and the remainder of the examination are normal.

An electrocardiogram shows normal sinus rhythm with no evidence of preexcitation.

Which of the following is the most appropriate diagnostic testing option?

A 48-year-old woman is evaluated during a new-patient visit. She reports no symptoms. She runs 5 miles a day 5 days per week. Medical history is otherwise unremarkable. She takes no medications.

On physical examination, vital signs are normal. The estimated central venous pressure is 6 cm H2O. Cardiac examination reveals a grade 2/6 holosystolic murmur that is best heard at the apex and radiates toward the axilla. An ejection click is not audible. The lungs are clear to auscultation. No edema is present.

Which of the following is the most appropriate management?

A 76-year-old woman is evaluated before discharge. She was diagnosed with a non–ST-elevation myocardial infarction 3 days ago. She declined angiography, and nuclear stress testing revealed a small lateral perfusion defect and normal left ventricular ejection fraction. She has had no further discomfort since admission. Medical history is significant for hyperlipidemia, hypertension, and transient ischemic attack. Medications are low-dose aspirin, ramipril, metoprolol, and atorvastatin.

On physical examination, vital signs and the remainder of the examination are unremarkable.

In addition to low-dose aspirin, which of the following is the optimal antithrombotic regimen for this patient?

A 65-year-old man was hospitalized 24 hours ago with findings of a large anterior myocardial infarction. He underwent primary percutaneous coronary intervention with stent placement in the proximal left anterior descending artery. He is currently asymptomatic. Medical history is significant for hyperlipidemia and hypertension. Medications are atorvastatin, aspirin, prasugrel, captopril, and metoprolol.

On physical examination, temperature is normal, blood pressure is 110/65 mm Hg, pulse rate is 65/min, and respiration rate is 18/min. Oxygen saturation is 98% breathing ambient air. The remainder of the examination is unremarkable.

An electrocardiogram obtained in the coronary care unit is shown.

Which of the following is the most appropriate treatment?

A 48-year-old man is evaluated in the emergency department for epigastric discomfort and nausea that began 45 minutes ago. Medical history is significant for hypertension, tobacco use, and hyperlipidemia. His only medication is atorvastatin.

On physical examination, temperature is normal, blood pressure is 110/60 mm Hg, pulse rate is 90/min, and respiration rate is 18/min. Oxygen saturation is 98% breathing ambient air. The remainder of the physical examination is unremarkable.

Laboratory studies are notable for an elevated initial serum troponin I level.

An electrocardiogram shows 3-mm ST-segment elevations in leads II, III, and aVF. A chest radiograph is normal.

The patient is administered aspirin, clopidogrel, and a bolus of heparin. Transport to the nearest hospital capable of percutaneous coronary intervention would take 4 hours.

Which of the following is the most appropriate management?

A 72-year-old woman is evaluated during a follow-up visit. She has a 3-year history of heart failure with a left ventricular ejection fraction of 25% and New York Heart Association functional class III symptoms. She has an implantable cardioverter-defibrillator. She reports manageable lightheadedness with standing. Medications are lisinopril, carvedilol, and spironolactone at maximally tolerated doses.

On physical examination, the patient is afebrile, blood pressure is 98/64 mm Hg, and pulse rate is 68/min. The estimated central venous pressure is 6 cm H2O. An S3 is present. The lungs are clear to auscultation. There is no lower extremity edema.

Which of the following is the most appropriate management?

A 45-year-old man is evaluated during a second follow-up visit after hospitalization for new-onset heart failure with reduced ejection fraction. His ejection fraction at the time of diagnosis 2 months ago was 42%. He reports feeling better, with improving exercise tolerance and no exertional dyspnea. Medications are lisinopril, low-dose carvedilol, and furosemide. He is black.

On physical examination, the patient is afebrile, blood pressure is 120/76 mm Hg, pulse rate is 84/min, and respiration rate is 16/min. The estimated central venous pressure is normal. There is no S3. Lungs are clear, and there is no peripheral edema.

Which of the following is the most appropriate treatment?

A 79-year-old woman is evaluated in the emergency department for palpitations that have occurred intermittently over the past 48 hours. Medical history is significant for hypertension and hyperlipidemia. Medications are low-dose aspirin, atorvastatin, and lisinopril.

On physical examination, temperature is 36.8 °C (98.2 °F), and blood pressure is 110/74 mm Hg. The resting pulse rate is 110/min with intermittent irregularity. The estimated central venous pressure is normal. Cardiac examination reveals tachycardia with a split S2. The lung fields are clear. The extremities are warm and well perfused without edema.

An electrocardiogram is shown.

Which of the following is the most appropriate next step in management?