A 38 year old male with a history of asthma presents to the emergency department with chest pain. He complains of intermittent left side chest pain ongoing for months, worsening over last week. Chest pain is not exertional or positional. He also complains of palpitations with occasional “pauses.” During these episodes the patient complains of lightheadedness. He denies shortness of breath or syncope. Patient endorses history of sudden cardiac death in his cousin at age 35. Initial vitals are notable for BP 133/88, HR 51, RR14 and O2 saturation of 98% on room air. The patient’s initial EKG (Figure 1) is shown.

Abish Kharel MD and Ari Edelheit MD