A 34-year-old African American man came to the emergency department (ED) complaining of chest pressure and shortness of breath, 2 hours in duration. He admitted to smoking cocaine for the first time 2 days ago and inhaling 1 g at a party 1 hour before the onset of symptoms. The patient had been in good health, did not smoke cigarettes or drink alcoholic beverages, and ran 5 miles daily. There was no family history of heart disease. On physical examination, he was agitated, blood pressure 180/100 mm Hg, heart rate 130/min and regular; there was an S4, S1, and S2, no murmurs were heard. Findings on chest radiographs were normal, and the electrocardiogram (ECG) revealed cove-plane T waves in V2-V6 (Figure 1). The level of the first set of...

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