A current smoker in their 50s with uncontrolled hypertension presented with acute substernal chest pain and shortness of breath. On presentation, their blood pressure was 206/97 mm Hg, heart rate was 106 beats per minute, and they had an elevated high-sensitivity troponin level of 125 ng/L (upper level of normal, 15 ng/L). The presenting electrocardiogram (ECG) is shown (Figure). The chest pain continued despite treatment with intravenous nitroglycerine. Results of an echocardiogram revealed hypokinesis of the distal septum with a mildly reduced left ventricular ejection fraction of 40% to 50%.