An 84-year-old male complains of chest pain that woke him from sleep. What should you suspect?

When evaluating an 84-year-old male who experiences chest pain that awakens him from sleep, acute coronary syndrome should be suspected as the primary concern. This scenario often indicates a serious underlying cardiovascular issue, particularly in older adults, who are at a higher risk for heart problems.

Acute coronary syndrome encompasses a range of conditions related to sudden reduced blood flow to the heart, including unstable angina and myocardial infarction (heart attack). The nature of the pain, particularly if it is severe and disruptive enough to awaken someone from sleep, is characteristic of cardiac events. Elderly patients frequently present atypically, which can make it challenging to recognize these conditions. Thus, the combination of age, the type of pain described, and the timing (being awakened from sleep) strongly points toward a potential heart-related emergency.

The other options, while they could cause chest pain, do not typically align as closely with the alarm signal presented by this patient, especially considering his age and the nature of the complaint. Conditions like costochondritis, respiratory distress, or emphysema are less likely to present in such an acute and serious manner as acute coronary syndrome.