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A 46-year-old man with a history of hypertension presented in an urgent care center saying he’s had chest pain for 2 days. He also said the pain has been worsening each day, and today it is severe. He denies nausea, vomiting, or shortness of breath. On exam, he appears uncomfortable but has normal vital signs.

View the ECG captured above and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page.

Male With Severe, Worsening Chest Pain
Figure 1: Pre-hospital ECG
46-Year-Old Male With Severe, Worsening Chest Pain