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Chest Pain Risk Stratification — ABEM Board MCQ

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MediumCardiologyChest Pain Risk StratificationABEM Board

A 52-year-old with 6 hours of non-exertional chest discomfort has normal ECGs and high-sensitivity troponin T measurements at 0 and 2 hours below the 99th percentile with no significant delta. HEART score is 2. He is pain-free. What is the best disposition?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: E — Discharge home with shared decision-making and outpatient follow-up

Explanation lettering: D = shown as A · A = shown as B · E = shown as D · B = shown as E

Low-risk chest pain with serial negative hs‑cTn and low clinical risk can be safely discharged with return precautions and timely outpatient follow‑up or testing per shared decision-making. Routine admission or immediate stress/CT testing (A, D) is not required. Anticoagulation (C) and empiric DAPT (E) are not indicated without evidence of ACS.

Reference: AHA/ACC (2021): Guideline for the Evaluation and Diagnosis of Chest Pain