An older adult with shortness of breath and chest pain

A 72-year-old female presented with the complaints of chest pain and shortness of breath. She describes the pain as sudden onset of severe pain, which feels like heavy pressure or tight sensation in her chest, radiating to her arm and jaw. This pain started about two hours prior her visit. She has a past medical history of hypertension, type 2 diabetes mellitus and hyperlipidemia. She denies recent physical exertion, trauma, stress, fever, or cough. She appears anxious and diaphoretic. On physical examination, her blood pressure is 160/90 mmHg, heart rate 95 bpm, respiratory rate 20 breaths per minute, oxygen saturation 95% on room air, temperature 36.7°C. Cardiovascular examination indicates no jugular venous pressure elevation. Apical impulse not displaced. Normal S1 and paradoxical splitting of S2 were noted. Chest is clear on auscultation, with no murmurs, gallops, or rubs. ECG findings reveal a left bundle branch block (LBBB). Chest x-ray reveals mild cardiomegaly and no pulmonary congestion. Troponin I levels are elevated.