What is the most appropriate plan of care for a 65-year-old woman with atypical chest discomfort and normal ECG and initial troponin levels?

The most appropriate plan of care for a 65-year-old woman experiencing atypical chest discomfort, along with a normal ECG and initial troponin levels, is to keep her in the chest pain unit or emergency department for observation and further evaluation.

Monitoring her in a controlled setting allows for ongoing assessment of her symptoms and cardiac status. Atypical chest pain can be challenging to diagnose, and while her initial tests are reassuring, there is still a possibility of evolving cardiac issues, particularly given her age.

During observation, healthcare providers can conduct further evaluations, such as repeat troponin tests, more detailed cardiac imaging, or additional diagnostic tests that may provide further clarity about her condition. This approach ensures that if her symptoms worsen or if there are changes in her test results, interventions can be implemented promptly.

Taking her immediately to the cardiac cath lab is unnecessary given the absence of significant findings on her initial tests. Admission to the ICU for continuous monitoring might be excessive without evidence of severe cardiac events, which her current presentation does not suggest. Discharging her with a recommendation for follow-up could pose risks, as it may leave undiagnosed conditions unmonitored, particularly if her symptoms persist or change. Thus, maintaining her in the chest pain