A previously healthy and active 28-year-old male was hospitalized for a 3-hour history of sharp substernal chest pain that radiated to his jaw. The patient was uncomfortable, diaphoretic, and tachycardic. His initial heart rate and blood pressure were 120 bpm and 145/64 mmHg, respectively. The cardiac apex appeared to be hyperdynamic and peripheral pulsations were prominent. Otherwise, a quick physical examination was noted to be negative. The electrocardiogram (ECG) showed up to 5 mm diffuse ST elevation, interpreted as acute ST elevation infarct (STEMI) (Figure 1). The patient underwent emergent cardiac catheterization that did not show any coronary abnormality. On further questioning, he admitted to a 3-month history of hot flashes, sweating, palpitation, tremor, and 20-pound weight loss. Cardiac troponins remained negative.
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