A patient is mowing his lawn on a hot Saturday afternoon. He begins to notice chest pain. What should his first action be?

Choice A rationale While taking a nitroglycerin tablet is a common treatment for angina, it should not be the first action. The immediate priority is to stop the activity causing the increased myocardial oxygen demand. Continuing to exert oneself can worsen myocardial ischemia and potentially lead to a more severe cardiac event, such as a myocardial infarction. Choice B rationale The primary action should be to stop the activity immediately and rest. Mowing the lawn is a strenuous activity that increases the heart's workload and oxygen demand. By stopping and resting, the patient decreases myocardial oxygen consumption, which can help alleviate the chest pain and prevent further myocardial ischemia. Choice C rationale While moving inside to cool off and get water may seem helpful, it is not the most critical first step. The immediate need is to reduce the cardiac workload, which is best achieved by ceasing the physical exertion. A patient should first sit or lie down to rest, as this action directly addresses the increased oxygen demand. Choice D rationale Calling 911 is crucial if the chest pain does not subside with rest or if it worsens. However, it is not the very first action to take. The initial step is always to stop the activity and rest, as this may be sufficient to resolve the symptoms. If the pain persists after resting, then it is appropriate to seek immediate emergency medical help.