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A 62-year-old male with hypertension, diabetes, and coronary artery disease presents with sudden onset chest pain for the past two hours. The patient describes the pain as a tearing sensation in the center of his chest without any radiation. The patient endorses feeling nauseous and sweaty. The patient’s vitals signs are as follows: temperature is 98.7 deg F (37.1 deg C), blood pressure is 173/68 mmHg, pulse is 92/min, respirations are 14/min. An electrocardiogram demonstrates left axis deviation but no ST segment changes, Q waves, left bundle branch morphology, or T wave inversions are seen. The patient’s troponin level is 0.05 ng/mL. A chest radiograph demonstrates the following findings (Figure A). Which of the following is the most appropriate next diagnostic step?
Left heart catheterization and angiogram
Thoracic and abdomen CT angiogram
Thoracic and lumbar spine radiograph
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