Case: 45 y/o M with Chest Pain – Need Input!!

Hi, Just had a 45 y/o M in the ED c/o central chest pain for ~4 hrs. Pain is non-radiating, dull, and “heavy.” No N/V, but mild SOB. No recent trauma. Hx of HTN, on amlodipine, no other meds. Smoker (10/day), no alcohol. BP: 168/92 HR: 96 (reg) RR: 20 SpO2: 97% RA Temp: 36.8°C ECG shows mild nonspecific ST changes, nothing definitive. Trop T pending, but bedside POC trop neg so far. CXR NAD. He's pain-free now after 300mg aspirin + GTN x2. Risk Strat: Would you throw this into the “low-risk ACS” bucket or keep the alarm bells on? HEART score = 4. Next Steps: If serial trop comes back neg, is it worth pushing for early discharge with GP f/u, or would you advocate for Obs overnight? Imaging: No red flags on exam or hx, but would you go straight for a D-dimer/CTPA if trop stays neg, just to rule out atypical PE? Secondary Prevention: Assuming ACS is confirmed, what’s your go-to cocktail in a patient like this? Anything extra I should consider re: smoking cessation? Cheers!!