The emergency department staff began treatment for a woman who presented with chest pain. The pain is described as retrosternal, worse with minimal activity, better with rest, sharp in character and 9/10 in intensity. You are paged to admit her to the intensive care unit under the working diagnosis of unstable angina. Her vitals have remained stable after beginning antiplatelet, antihypertensive and antithrombotic medications. Two hours after admission, a repeat history and physical and review of available test results offers the following information: Serial electrocardiograms reveal increasing R wave amplitude; An echocardiogram calculates an ejection fraction of 50%; Angina is reported as 9/10 in intensity; Atrial natriuretic peptide levels are elevated. Which of the following historical facts would prompt you to immediately consult interventional cardiology for invasive coronary revascularization?
50% ejection fraction
Continued chest pain
Elevated atrial natriuretic peptide
R wave progression