A 57-year-old practicing attorney, moderately obese with a sedentary habitus, presented to the emergency department (ED) with precordial pressure radiating to the left jaw, shoulder, and inner aspects of the left arm to the third, fourth, and fifth fingers. These symptoms occurred after lunch and 30 minutes before arrival at the ED; they were accompanied by mild dyspnea, and the entire episode lasted 5 minutes. An electrocardiogram (ECG) taken about 5 minutes after spontaneous symptom relief with the patient asymptomatic revealed flattened ST-T segments with 1-mm ā€œJā€ depression in leads I, aVL, V5, and V6. His blood pressure was 145/90 mm Hg, and his heart rate was 90 beats/minute and regular. There were an S4, S1, and S2, and a grade 2/6 aortic systolic murmur was heard at the...

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