Use the following patient vignette to answer questions 4 – 8…
Use the following patient vignette to answer questions 4 – 8. A 55-year-old man reaches the ED with a chief complaint of chest pain. He describes it as crushing, heavy pain in the left substernal area, present for the last 95 min at rest. He reports another episode of chest pain about 1 year before. In that case, pain was more ‘stabbing’ and felt primarily in the back. Clinical records of that event indicated that he complained of being mildly diaphoretic, mostly at night, and not necessarily in association with the stabbing pain symptoms. An ECG recorded in the ED showed slightly accelerated rhythm but no sign of ischemic sufferance. A chest X-ray determined it to be pneumonia. Aside from that episode, past medical history is notable for hypertension (160/100 mmHg) and dyslipidemia (hypertriglyceridemia and elevated total cholesterol and LDL, with slightly decreased HDL). The patient reports smoking 1 pack of cigarettes every 2-3 days, and to have 4-5 drinks per week. Currently, he is taking aspirin, hydrochlorothiazide (thiazide diuretic) and atorvastatin (statin). On physical examination, the patient is afebrile, blood pressure is 100/70 mm Hg, pulse is 100/min, and respiration rate is 20/min. There is no jugular venous distention and no cardiac murmurs or rales. Lungs are clear to auscultation. A blood sample is run to the laboratory for troponin I and CK-MB. An initial ECG is performed and the results are shown below. 4. Which of the following is the most likely diagnosis?