A 42-year-old man is brought to the emergency department by ambulance after a sudden onset of severe retrosternal chest pain that began an hour ago while he was at home. He describes the pain as sharp, constant, and unrelated to movement. The pain did not subside by three doses of sublingual nitroglycerin administered by the paramedics while on the way to the hospital. He has never had symptoms like this before. Medical History His only medical history is hypertension, for which he takes enalapril.
There is no cardiac disease in his family. He does not smoke, does not drink alcohol, or use illicit drugs. He is a basketball coach at a local high school and is usually physically very active. Physical Examination On physical examination, he is a tall man with long arms and legs who appears uncomfortable and diaphoretic; he is lying on the stretcher with his eyes closed. He is afebrile.…
