A 10-year-old previously healthy boy presents after “passing out” and experiencing chest pain while playing basketball with friends earlier that evening. The patient reports occasional chest pain with exertion. Today, he also had chest pain while running, collapsed, and had a loss of consciousness for 4 to 5 seconds. He then returned to baseline. He has no prior history of syncope and no recent infections. He denies drug use. On physical examination, there is no evidence of acute distress, and he has normal pulmonary and cardiac examinations. You immediately order an ECG. Do you also need to obtain troponins, D-dimer, or coagulation studies? Does he also need an echocardiogram? You want the patient to see a cardiologist, but does this need to happen in the middle of the night?
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