Review Question - QID 213803

A 61-year-old man presents to the emergency department with chest pain. He states that he has intermittent and severe episodes of sharp chest pain over his left lower chest. These pains can last for several seconds and seem to then spontaneously resolve. He states he is currently having the pain and notes that it is worse with deep breaths. The pain is not associated with exertion. The patient has a history of diabetes, chronic kidney disease, and dyslipidemia and is not compliant with his medications. He recently recovered from a viral infection. Physical exam is notable for a comfortable appearing man. Cardiopulmonary exam reveals a normal S1 and S2 with good air movement and minor bibasilar crackles. The pain is not reproduced with palpation or stretching of the patient's arms when they are behind his head. His ECG is notable for the finding in Figure A. Troponin levels are 0.60 ng/mL and 0.60 ng/mL (normal < 0.4 ng/mL) spaced 4 hours apart. His d-dimer is 500 mcg/L. An initial chest radiograph is unremarkable. Which of the following is the most likely diagnosis?