A 60-year-old male patient on aspirin, nitrates, and a beta blocker, being followed for chronic stable angina, presents to the ER with a history of two to three episodes of more severe and long-lasting anginal chest pain each day over the past 3 days. His ECG and cardiac enzymes are normal. The best course of action of the following is to

## **Core Concept**
The patient presents with an acute change in angina pattern, characterized by more severe and prolonged episodes of chest pain. This change in angina pattern suggests unstable angina, which is an acute coronary syndrome (ACS) that indicates a high risk of myocardial infarction. The management of unstable angina involves immediate stabilization and risk stratification.

## **Why the Correct Answer is Right**
The best course of action in this scenario is to admit the patient for further evaluation and management. This typically involves monitoring with serial ECGs and cardiac enzymes, and possibly more invasive diagnostic and therapeutic procedures like coronary angiography. Given the patient's presentation of unstable angina with normal ECG and cardiac enzymes but with a high-risk profile (change in angina pattern), hospital admission is crucial for close observation and to prevent myocardial infarction.

## **Why Each Wrong Option is Incorrect**
- **Option A:** This option is blank and cannot be evaluated.
- **Option B:** This option is also blank and cannot be assessed.
- **Option C:** Similarly, this option is blank and lacks information for critique.
- **Option D:** This option is blank as well.

## **Clinical Pearl / High-Yield Fact**
A key point to remember is that unstable angina, characterized by a change in the pattern of angina (e.g., more frequent, longer-lasting, or severe episodes), is a medical emergency that warrants immediate hospitalization for further evaluation and management to prevent myocardial infarction.

## **Correct Answer:** .

✓ Correct Answer: B. Admit the patient and begin intravenous heparin