A 21-year-old woman comes to the emergency depament with complaints of ‘constricting pain in chest’ and difficulty in breathing. The patient is sure that ‘she is having a hea attack’ . She has three similar episodes in the past one month. The past medical history is unremarkable, there is family history of myocardial infarction in father who died of it at the age of 47. The ECG shows sinus tachycardia, the cardiac enzymes and urine drug screen came out to be normal. What is the next best step in the management of this patient?

**Core Concept**
The patient's symptoms and family history suggest a possible diagnosis of panic disorder or anxiety-related chest pain, which can mimic myocardial infarction (MI). However, given the patient's perceived risk of MI due to family history, a thorough evaluation for coronary artery disease is necessary.

**Why the Correct Answer is Right**
The patient's normal cardiac enzymes and ECG, despite symptoms suggestive of MI, point towards a non-ischemic cause. In this scenario, stress-induced or anxiety-related chest pain is a common cause of chest pain without evidence of MI. The next best step is to assess the patient for panic disorder or anxiety-related conditions, which can be managed with psychotherapy, relaxation techniques, or medication. **Option B** is the correct answer because it directly addresses the need for further evaluation and management of the patient's symptoms.

**Why Each Wrong Option is Incorrect**
**Option A:** This option would be premature and incorrect as it assumes the patient is having a myocardial infarction without evidence of cardiac enzymes or ECG changes. Furthermore, immediate angiography would not address the patient's primary complaint of anxiety-related chest pain.

**Option C:** This option is incorrect because it does not address the patient's symptoms or family history. While a family history of MI may increase the patient's perceived risk, it does not necessitate immediate coronary angiography without evidence of MI.

**Option D:** This option is incorrect because it does not address the patient's primary complaint of anxiety-related chest pain. While a stress test may be useful in evaluating for cardiac causes of chest pain, it is not the next best step in this scenario.

**Clinical Pearl / High-Yield Fact**
It's essential to remember that anxiety-related chest pain can mimic MI, and a thorough evaluation is necessary to rule out cardiac causes. A normal ECG and cardiac enzymes do not exclude MI, but they do suggest a non-ischemic cause.

**Correct Answer:** B. Further evaluation and management of the patient's symptoms for panic disorder or anxiety-related conditions.

✓ Correct Answer: B. Alprazolam