Case History/examination:
A 42-year-old male presented to the emergency department with the acute onset of stabbing chest pain radiating to his back and left arm, accompanied by diaphoresis and nausea. He reported recent cocaine use earlier that morning. Upon arrival, his vital signs were a blood pressure of 126/91 mmHg, heart rate of 109 bpm, and oxygen saturation of 99%. The patient had a history of smoking approximately half a pack of tobacco per day since he was 19 years old, and reported weekend alcohol consumption of about six packs of beer and a pint of vodka per session. Notably, he had consumed four shots of rum the day before admission.