This article will outline emergent/early therapy challenges for individuals with acute coronary syndrome.

The case

A 53-year-old gentleman arrived at his local emergency unit with diaphoresis and chest discomfort lasting 20 minutes. The central chest discomfort was crushing in character, spreading to the left arm. The discomfort subsided quickly when the emergency doctor delivered 300 mg aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray sublingually.

He smoked around 30 cigarettes daily and was unaware of any additional risk factors for cardiovascular disease. On inspection, he looked to be at ease and was capable of completely completing phrases. Cardiovascular auscultation revealed no heart murmurs. The blood pressure was 180/105 mmHg, the heart rate was 83 beats per minute and normal, and the oxygen saturation level was 97 per cent.

Which of the following is the most probable diagnosis?