A 47-year-old old Caucasian man presents with three hours of severe unrelenting retrosternal chest tightness. This is associated with shortness of breath and sweating. The discomfort started when he was chopping wood (usual activity) but would not get relieved with rest, water and Tums. He has never had chest Pain before and has not seen a doctor for over 10 years. He smokes two packs of cigarettes a day and has been doing so for over 30 years. He denies HTN and Diabetes. His brother (age 51) had a 3 vessel CABG 2 years ago and is doing well.

1.What is the likely diagnosis?
2.What is the differential diagnosis?
3.How will the diagnosis be confirmed?
4.What does the EKG show?
5.What is the likely pathology of the event?
6.How should this patient be treated?