A 25-year-old G2P1 female with a past medical history of fetal demise 4-5 months prior to this Emergency Department (ED) visit presents with chest pain and palpitations that started at 1:00 AM, approximately 10 hours prior to arrival. Her pain is central and constant without associated cough, shortness of breath, or increased work of breathing. She reports one similar episode of palpitations that resolved spontaneously 2 weeks ago. Mourning a recent loss, she has been drinking approximately 7 beers per shift in her new job as a bartender over the past several months. Her last drink was 2 days ago. She has no history of dysrhythmia, venous thromboembolism, diabetes mellitus, hypertension, alcohol use disorder, or alcohol withdrawal. There is no family history of sudden cardiac death. An index ECG was obtained in triage (Figure 1).

Leslie Cachola, MD and Ari Edelheit, MD