A 56-year-old man enters your hospital urgent care center complaining of moderately severe chest pain. His pain is substernal and left anterolateral, with some exacerbation on inspiration, and has been increasing in severity over the last 36 hours. He works as a truck driver and has a history of heavy cigarette smoking, hypertension, and obesity. For the last week, he had experienced swelling and discomfort in his right calf.
Examination shows: BP- 90/55 mm Hg, P- 122/min, RR -40/min, Temp- 37.6° C. He is mildly agitated and confused. Systemic examination reveals: Heart: tachycardia, soft systolic murmur, questionable ventricular gallop. Chest: dullness to percussion left base with scattered crackles and wheezes throughout.
