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What diagnostic test, including labs, would you order to establish the vital risk of this patient?What ECG changes have you noticed that support this diagnosis?

Case Study of Chest Pain
A 40-year-old male presents to the outpatient clinic complaining of chest pain that started 24 hours ago. The patient states the chest pain has been increasing in intensity for the last hours  and it was described as sharp. Pain relieved by sitting down and worse in lying flat. The patient does not have any past medical history or risk factors. On physical examination was found that vital signs were unremarkable and on auscultation, the provider noticed a sound like “rhonchi “while the patient was holding off his respiration.
1. What would be the initial diagnosis for this patient?
2. Mention the four most important elements that support the diagnosis above
3. What diagnostic test, including labs, would you order to establish the vital risk of this patient?
4. What ECG changes have you noticed that support this diagnosis?

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