A 20-year-old college basketball player is brought to the university urgent care clinic after developing chest pain and palpitations during practice. There is no dyspnea or tachypnea. He denies family history of cardiac disease, and social history is negative for alcohol or drug use. Cardiac auscultation is unremarkable, and ECG shows frequent premature ventricular contractions (PVCs). Which of the following is the most appropriate next step in evaluation and/or management?
The question of cocaine and/or amphetamine use must be raised in virtually all young adults with cardiovascular symptoms, despite a professed negative history. Therefore, a urine drug screen should be obtained early on. In the absence of dyspnea, recent immobilization, or physical examination evidence of venous thrombosis, workup for asthma or DVT would not be warranted. Beta-blockers can be used for symptomatic treatment of PVCs but not until the more serious issue of substance abuse has been addressed. Cardiovascular complications from cocaine and methamphetamine use include hypertension (which may be severe), arrhythmias, myocardial infarction, stroke, and sudden death.
Obtain urine drug screen
Arrange treadmill stress test
Obtain Doppler ultrasound of deep veins of lower legs
Institute cardio-selective beta-blocker therapy
C.V.S.