M.R. is a 56-year-old general contractor who is admitted to your telemetry unit directly from his internist’s office with a diagnosis of chest pain. On report, you are informed that he has an intermittent w-month history of chest tightness with substernal burning that radiates through to the mid-back intermittently in a stabbing fashion. Symptoms occur, after a large meal; with heavy lifting at the construction site; and in the middle of the night when he awakens from sleep with coughing, shortness of breath, and a foul, bitter taste in his mouth. Recently, he has developed nausea, without emesis, that is worse in the morning or after skipping meals. He complains of “heartburn” three or four times a day. When this happens, he takes a couple of Rolaids or Tums. He keeps a bottle at home, at the office, and in his truck. Vital signs(VS) at his physician’s office were 130/80 lying, 120/72 standing, 100,20,98.6˚F(37˚), Spo₂ 92% on room air. A 12-lead ECG showed normal sinus rhythm with a rare premature ventricular contraction(PVC).