A 51-year-old male with past medical history of hypertension, hyperlipidemia, and coronary artery disease presents to the emergency room with complaints of palpitations, profuse sweating, and a stiff neck for the last two days.

His symptoms have gradually progressed. He denies any similar episodes in the past, sick contacts, or recent travel. On the physical exam, you notice a bandage on the plantar aspect of his right foot. When inquired, he states that he stepped on an old nail while...