A 71 Year Old Woman Has Severe Sudden Onset Chest

a 71 year old woman has severe sudden onset chest pain radiating to her neck. She says it feels like heartburn but much worse and is worse on exertion. She feels nauseous. She has no cardiac history. A chest x-ray has shown a normal heart size and a little unfolding of the ascending aorta at least in part due to rotation of the patient to the right.