Review Question - QID 216638

A 55-year-old man presents to the emergency department with chest pain. He states that every day when he mows the lawn he gets chest pain that goes away with 15 minutes of rest. Today, he had the same pain, but his wife forced him to come to the hospital to be evaluated. He is currently pain-free. His past medical history includes diabetes, hypertension, and a 30 pack-year smoking history. His temperature is 99.2°F (37.3°C), blood pressure is 160/95 mmHg, pulse is 92/min, respirations are 18/min, and oxygen saturation is 100% on room air. A physical exam reveals an obese man in no acute distress. An ECG is performed as seen in Figure A. The patient declines laboratory testing or any medications. An exercise stress test is performed but is terminated at the patient's request, as he develops chest pain when walking at higher speeds. Which of the following is the most likely diagnosis?