A 55-year-old man with alcohol use disorder presents to the emergency department after experiencing severe chest pain. He is an obese male with a significant medical history that includes coronary artery disease, sleep apnea, hypercholesterolemia, as well as early liver cirrhosis. The patient states the chest pain started about 18 h ago, after consuming far too much food at a buffet and binge drinking leading to him feeling ill and forcefully vomiting. There was no blood in the vomitus. He states the pain is in his lower chest and radiates to the left side, back, and upper abdomen. The pain is aggravated by swallowing. At initial exam, his blood pressure is 105/90 mmHg, heart rate is 120/min, respiratory rate is 26/min, and temperature is 38.6 °C. He has crepitus with palpation around the sternum. His abdomen is soft and non-tender. A chest X-ray shows a left-sided pleural effusion. Laboratory examination is significant for a white blood count of 17 × 103/μL (normal 4.1–10.9 × 103/μL) with 15% bands (normal <5% bands). Serum troponin-I is 0.1 ng/mL (normal <0.4 ng/mL).