A 42-Year-Old Woman with Short-Term Dizziness and Vomiting

Case
This 42-year-old woman presents to your urgent care center with a 2-hour history intermittent dizziness and vomiting. She denies diarrhea or exposure to ill persons. Further history reveals that she has recently had some epigastric discomfort.

In the exam room, she is alert and oriented. She seems comfortable, in fact. In addition, you find:
Lungs: Minimal bilateral symmetric wheezing
Cardiovascular: Regular rate and rhythm without murmur, rub, or gallop
Abdomen: Soft and nontender without rigidity, rebound, or guarding. No epigastric discomfort with palpation
Extremities: No pain or swelling of the lower extremities; pulses are 2+ and equal in all 4 extremities

Just as you are getting ready to write a prescription for an antiemetic, the patient breaks out in a sweat. You order an ECG.