Simple and Complex

A 44-year-old man presented to the emergency department with chest pain that had started 1 hour earlier and had awakened him from sleep. The pain was severe, substernal, burning, radiating to the left arm, and accompanied by nausea and nonbilious, nonbloody vomiting. For the past month he had experienced intermittent chest pain of a similar character but less intense. The pain was not related to exertion and lasted for hours to days at a time. Antacids and omeprazole had provided temporary relief. He reported no dyspnea, lower-extremity edema, immobility, fever, cough, or trauma. Mehr