A 65-year-old female presenting with 3 days of shortness of breath, right arm paresthesias, and anxiety. She had a history of being treated for musculoskeletal symptoms and panic attacks. On examination she appeared confused, tachypneic, combative, autonomically instable, choking, gasping, and distressed. Notable laboratory values included troponin, 7.8 ng/mL; potassium, 2.8 mg/dL; lactic acid, 8.78 mmol/L; bicarbonate, 14 mmol/L; and anion gap, 22. Cardiac catheterization demonstrated clear coronary arteries.
A transthoracic echocardiogram demonstrated normal ejection fraction and trivial pericardial effusion. A twelve-lead electrocardiogram result is shown in the image. On enquiring about animal exposure, she revealed being bitten by a stray dog 5 weeks ago.
