MRCP2-0462

MRCP2-0462

A 57-year-old man presents to the Emergency department with central chest pain that has been radiating to his shoulder and the left side of his mouth for the past three hours. He has no history of exertional chest pain or known cardiac issues, but has been taking propranolol for migrainous headaches for the past three years. On examination, he appears sweaty, clammy, and distressed with a blood pressure of 165/90 mmHg. He is also breathless with fine inspiratory crepitations audible up to the mid-zones bilaterally, and his oxygen saturations are at 89% on air by pulse oximetry. His chest x-ray shows upper lobe venous diversion bilaterally with fluid in the horizontal fissure, and his ECG shows ST elevation in leads V1 to V5 and a resting sinus tachycardia.

What is the most definitive treatment option for this patient?