A patient in their 20s presented to the emergency department complaining of severe midsternal chest pain of several hours’ duration. The patient was in very good health before their presentation. The patient was not taking any medications and had no risk factors for coronary artery disease. They used cocaine 3 to 4 hours before presentation. Physical examination showed that the patient was thin, anxious, and in acute distress. The patient was diaphoretic and tachypneic. Their blood pressure was 138/80 mm Hg with a regular pulse of 180 beats per minute; they did not have a fever. The patient had a questionable S4, but otherwise their examination was unremarkable. An electrocardiogram (ECG) was conducted (Figure, A). The tachycardia spontaneously ended within 1 to 2 minutes, and a repeated ECG was obtained (Figure, B).
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CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.
Corresponding Author: Mazen M. Kawji, MD, OSF Healthcare, 1050 E Norris Dr, Ste 1B, Ottawa, IL 61350 (email@example.com).
Published Online: July 24, 2023. doi:10.1001/jamainternmed.2023.1737
Conflict of Interest Disclosures: None reported.
Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:
It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.
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