A 58-year-old male presents to the emergency department with a sudden onset of severe chest pain that started while he was at rest. He describes the pain as a crushing sensation in the center of his chest, radiating to his left arm and jaw. The pain is associated with shortness of breath, sweating, and nausea. He is visibly anxious and in distress. His medical history includes hypertension, hyperlipidaemia, and a 30-pack-year history of smoking. He has been non-compliant with his antihypertensive and cholesterol medications.

On examination, his blood pressure is 145/90 mmHg, heart rate is 105 beats per minute, and respiratory rate is 20 breaths per minute. He appears diaphoretic and in moderate distress. Cardiovascular examination reveals a regular rhythm, with no murmurs or gallops. An electrocardiogram (ECG) shows ST-segment elevation in the anterior leads, and his cardiac biomarkers (troponin I) are significantly elevated.

The patient is diagnosed with an acute anterior wall myocardial infarction. He is started on aspirin, clopidogrel, and heparin, and prepared for emergent coronary angiography. He is monitored closely in the intensive care unit, and a decision for percutaneous coronary intervention (PCI) is made. Further management includes optimizing his medications, lifestyle changes, and referral for cardiac rehabilitation post-discharge.