Question: A 58-year-old man presents with a 2-hour history of severe, crushing chest pain that radiates to his left arm and jaw on your airplane. He describes the pain as 9/10 in intensity and states that it started while he was resting. He has a history of hypertension, hyperlipidemia, and a 30-pack-year smoking history. He has no known drug allergies. On examination, he appears diaphoretic and anxious. His vital signs are as follows- blood pressure 150/90 mmHg, heart rate 95 beats per minute, respiratory rate 22 breaths per minute, and oxygen saturation 80% on room air. Cardiac auscultation reveals no murmurs, rubs, or gallops. Lungs are clear to auscultation. An ECG is performed, showing 3 mm ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and aVL. His initial troponin I level is 0.08 ng/mL (reference range- <0.04 ng/mL). Echocardiogram is obtained with results available below. Here are the echocardiogram results. Echocardiogram Report      Patient Name: XXXXXXX     Medical Record Number: XXXXXXX     Date of Study: XXXXXXX     Indication: Evaluation of cardiac function in a 58-year-old male with acute inferior ST-elevation myocardial infarction (STEMI)            Findings:      1. Left Ventricle (LV):              Size: Normal         Wall Motion: Regional wall motion abnormalities (RWMA) noted.                      Inferior Wall: Severe hypokinesis/akinesis observed in the inferior wall and inferoseptal segments.             Global Systolic Function: Moderately reduced left ventricular ejection fraction (EF), estimated at 40%.                  Overall Function: Consistent with myocardial ischemia/infarction involving the RCA territory.           2. Mitral Valve:              Structure: Leaflets and chordae appear intact.         Function: Mild to moderate mitral regurgitation (MR) noted, likely secondary to papillary muscle dysfunction. No evidence of flail leaflet.           3. Right Ventricle (RV):              Size and Function: Normal size with preserved systolic function.           4. Pericardium:              No evidence of pericardial effusion.           5. Atria:              Left Atrium (LA): Normal size.         Right Atrium (RA): Normal size.           6. Aortic Valve:              Structure: Trileaflet, normal opening and closing.         Function: No aortic stenosis or regurgitation observed.           7. Tricuspid Valve:              Function: Trace tricuspid regurgitation (physiologic).         Right Atrial Pressure Estimate: Normal.                 Conclusion:              Severe hypokinesis/akinesis of the inferior wall of the left ventricle, consistent with regional wall motion abnormalities in the setting of acute inferior STEMI.         Moderately reduced LV ejection fraction (EF) at approximately 40%, suggesting impaired systolic function.         Mild to moderate mitral regurgitation, likely secondary to papillary muscle dysfunction associated with the inferior wall myocardial infarction.         No evidence of pericardial effusion.           Which of the following is the most appropriate next step in management?
A. Administer sublingual nitroglycerin and monitor in the emergency department
B. Connect to oxygen
C. Take the patient for emergent cardiac catheterization
D. Administer a thrombolytic agent
E. Order a chest X-ray to rule out aortic dissection
Answer: B