A 45-Year-Old Man Comes to the Office After Experiencing Left-Sided

A 45-year-old man comes to the office after experiencing left-sided chest pain for a day.  The pain is nonradiating and constant and increases with movement of the left hand.  The patient has had no nausea, dyspnea, diaphoresis, lightheadedness, or syncope.  He has a 25-pack-year smoking history.  Vital signs are within normal limits.  On examination, the pain is reproduced with palpation of the left-sided chest wall muscles.  ECG reveals no significant ST-segment or T-wave abnormalities.  The rhythm strip is shown in the exhibit.  Which of the following is the best approach to this patient's ECG findings?

A) 24-hour ECG monitoring
B) Electrophysiology study
C) Observation
D) Permanent pacemaker
E) Vagal maneuver

Correct Answer:

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