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A 50 yrs old male patient,an alcoholic and smoker presents with a 3 hour history of severe retrosternal chest pain and increasing shortness of breath.He started having this pain while eating,which was constant and radiated to the back and interscapular region.He was a known hypertensive.On examination,he was cold and clammy with a heart rate of 130/min,and a BP of 80/40 mmHg.JVP was normal.All peripheral pulses were present and equal.Breath sounds were decreased at the left lung base and chest x-ray showed left pleural effusion.What is the most likely diagnosis?
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