Three years have now gone by and Novak B. has done very well. He has used his Nitroglycerin only once since you prescribed it, when he had to run for a bus. One night, you happen to be working an ER night shift at the local hospital when Novak is brought in by an ambulance. He is complaining of severe retrosternal chest pain, which started one hour ago. An EKG is obtained immediately and confirms an acute myocardial infarction (AMI). A chest X-ray is normal, as is his first Troponin T. You give him 162 mg of aspirin to chew, along with 180 mg of ticagrelor and enoxaparin 80 mg subcutaneously every 12 hours, as a starting dose. On examination, he is in distress from the pain and looks dyspneic. His pulse is 90 bpm and his respiratory rate is 24. His blood pressure is 100/70 mmHg in both arms. His O2 saturation is 90% on 2L oxygen via nasal prongs. His JVP is 5 cm above the sternal angle. He has bibasilar inspiratory crackles. His heart sounds are obscured by the ambient noise in the ER, but no obvious murmurs are heard. He has no peripheral edema. You briefly discuss percutaneous coronary intervention (PCI) and thrombolytic therapy. Novak does not consent to thrombolysis, but agrees to PCI.