47 year old man experiencing severe chest pain with exertion - Diagnosis

Patient Chart History: Patient seen in emergency room complaining of severe chest pain while running in the bay-to-breakers foot race in San Francisco. Patient has type II diabetes and is currently on oral hypoglycemic medication. Strong family history of heart disease. Father died of coronary artery heart disease in early 40s.

Physical Exam
Admitted with heart rate of 110.
Blood pressure 100/65

Test Results: CVC and platelet count normal.
Serum sodium count normal.

Heart Sounds:

Diagnosis What is your diagnosis?

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Case #235