44-year-old otherwise healthy male presents to the emergency department with chest pain. The pain started yesterday mid-day and is described as central and substernal with radiation across the chest and up into the throat. The patient also reports shortness of breath worse with deep breathing and exertion. The patient is incarcerated but otherwise has no historical risk factors for tuberculosis, pulmonary embolism, or cardiac disease. An EKG (Figure 1) is obtained.

Michael Hohl MD and Ari Edelhiet MD