患者，男，65岁。突感胸骨后剧烈疼痛，取硝酸甘油片含服，未能缓解。査体：脸色青白，血压80/60mmHg(10.67/7.98kPa),除心率140次/分外，心肺听诊无异常，腹平软，无压痛、反跳痛，肠鸣音存在。应首先考虑的是

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