A 42-year-old man presents to the hospital with dull, anterior precordial and retrosternal chest pain that began acutely with a tearing sensation and has lasted for 3 days. He states that during this period he has been unable to "get comfortable." The intensity of the pain increases during inspiration and with body movement. The patient denies any symptoms of recent viral infection, and he has received no recent vaccinations. He has no reported history of hypertension, coronary artery disease, prior cardiac surgery, diabetes mellitus, or hyperlipidemia. He has no family history of cardiovascular disease.
The patient is taking no prescribed medication, over-the-counter medication, or herbal remedies, and he denies illicit drug use. Physical Examination and Workup The patient is alert but appears uncomfortable. He is afebrile. His blood pressure is 160/102 mm Hg in all extremities, with…
