A 73-Year-Old Man With Chest Pain 4 Days After a Fish Dinner

A 73-year-old man with a medical history significant for hypertension, smoking, and dyslipidemia presented to the emergency department complaining of chest pain. Symptoms had begun 4 days prior to hospital admission, and consisted of a sharp, substernal pain, starting shortly after a meal, and progressing gradually over the next 72 h. The pain radiated to the patient’s left shoulder and scapula, and was pleuritic. Eventually, the patient experienced dyspnea and near-syncope. The medical history was unremarkable.