A 38 year old man presents with left-sided tightening chest pain for 10 hours, with radiation to the neck. He also experienced a tingling sensation in his left arm and neck, and mild dyspnea and lightheadedness.

His medical history is significant for well controlled hypertension for 5 years. There is an extensive family history of ischemic heart disease, with his mother dying of a myocardial infarction in her early 50s.

He admits to inhaling cocaine and smoking marijuana about 30 minutes before the onset of the pain. He has a history of cocaine use for 10 years.