33.A 51-year-old woman presents to the ED after 5 consecutive days of
crushing substernal chest pressure that woke her up from sleep in the
morning. The pain resolves spontaneously after 20 to 30 minutes. She is an
avid rock climber and jogs 5 miles daily. She has never smoked cigarettes
and has no family history of coronary disease. In the ED, she experiences
another episode of chest pain. An ECG reveals ST-segment elevations and
cardiac biomarkers are negative. The pain is relieved with sublingual nitro-
glycerin. She is admitted to the hospital and diagnostic testing reveals min-
imal coronary atherosclerotic disease. Which of the following is the most
appropriate medication to treat this patient’s condition?
a. Aspirin
b. Calcium channel blocker (CCB)
c. β-Blocker
d. H 2 -Blocker
e. Antidepressant
34.A 23-year-old woman who is an elementary school teacher is brought
to the ED after syncopizing in her classroom while teaching. Prior to pass-
ing out, she describes feeling lightheaded and dizzy and next remembers
being in the ambulance. There was no evidence of seizure activity. She has
no medical problems and does not take any medications. Her father died of
a “heart problem” at 32 years of age. She does not smoke or use drugs. BP is
120/70 mm Hg, pulse rate is 71 beats per minute, RR is 14 breaths per
minute, and oxygen saturation is 100% on room air. Her physical exami-
nation and laboratory results are all normal. A rhythm strip is seen below.
Which of the following is the most likely diagnosis?
18 Emergency Medicine
a. Wolff-Parkinson-White syndrome
b. Long QT syndrome
c. Lown-Ganong-Levine syndrome
d. Complete heart block
e. Atrial flutter