A 53-year-old man presents with pain in his right arm following exertion, which is completely relieved by rest; numbness of his right upper arm; left-sided tinnitus; and slight unsteadiness—all for a period of one year. No other symptoms are present.

His medical and surgical histories are unremarkable. He is not on any medications currently. His family history is significant for coronary artery disease in his father and older brother. He stopped smoking two years ago, and has a total smoking history of 10 pack years. He only drinks socially.