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Why wouldn't you do a transesophageal echo, just to establish what you're dealing with?
I think since you already did an ECG and you know it's for sure 3rd degree AV block, TEE probably wouldn't change the management at all, so you wouldn't want to expose pt to extra risk of a procedure (however minor it may be).
I feel like more invasive testing typically is not the correct answer when you can avoid it, as a general theme.
@leaf_house - Whenever two imaging tests that are similar with advanced clinical decision making tools being used to decide which one to do (TEE vs TTE)- I generally assume that I can eliminate both as a choice- especially in this case where the definitive Tx is a choice.
I had narrowed it down to that and the correct answer. I think the difference is that esophageal spasm tends to present with pain and dysphagia. FA 2019 p. 371, right at the top of the page.
Relating the phrase "diffuse painful contraction" to esophageal spasm has helped me remember the associated descriptions they go to.