Kardiologischer Fall: 61-jähriger Mann mit substernalen Schmerzen, Dyspnoe und diffusem Schwitzen von Joseph Alpert, MD

A 61-year-old man with a long history of heavy cigarette smoking, hypertension, and hyperlipidemia experiences severe substernal chest discomfort, shortness of breath, and diffuse sweating at 7 AM. He decides that it is due to indigestion and takes several antacid pills before returning to bed. However, 5 hours later the pain is still present, and he presents to the emergency department. On physical examination, he is mildly confused, his skin is cool and clammy, his blood pressure is 85/55 mm Hg, and his heart rate 110 beats/min. His blood tests show a BUN level of 35 mg/dL and a creatinine level of 1.6 mg/dL. A 12-lead ECG shows ST-segment elevation over the V1–V5 leads. Which of the following is the most likely diagnosis?