A patient in their 50s with a history of hypertension, chronic obstructive pulmonary disease, heavy alcohol use, and tobacco use presented to the emergency department with a 2-month history of nausea and vomiting that worsened in the 3 days prior to presentation to the point that the patient had been unable to tolerate anything by mouth. The patient denied chest pain or dyspnea. On arrival, the patient was afebrile with a heart rate of 129 beats/min, blood pressure of 70/48 mm Hg, and oxygen saturation of 94% on room air. Physical examination revealed nonlabored respirations with clear lung fields bilaterally, normal heart sounds with no appreciable murmurs, and warm and well-perfused extremities. There was mild tenderness to palpation of the epigastrium. Pertinent laboratory findings included a high-sensitivity troponin T of 0.008 ng/mL (to convert to μg/L, multiply by 1.0), lactic acid of 3.8 mmol/L, creatinine of 1.5 mg/dL (to convert to μmol/L, multiply by 76.25), and white blood cell count of 11 900/μL (to convert to ×109/L, multiply by 0.001). A 12-lead electrocardiogram (ECG) was obtained (Figure).