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The patient is a 36-year-old male with a history of tobacco and alcohol use who presents to urgent care with sudden-onset substernal chest pain and shortness of breath that began 1 hour prior to arrival.              

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

Figure 1. Initial ECG (Case presented by Joshua Fan, MD, The University of Texas Health Science Center at Houston McGovern Medical School.)
A 36-Year-Old Male with Sudden-Onset Substernal Chest Pain