What’s the Next Step for Patient with Substernal Chest Pain, Dyspnea?

A 50-year-old female with a past medical history of diabetes presents to the emergency department with acute-onset substernal chest pain and dyspnea. Laboratory testing demonstrates a hemoglobin level of 10.5 g/dL and a troponin I of 2.5 g/dL. 

An electrocardiogram shows deep symmetrical T wave inversions in all precordial leads. 

She is taken for cardiac catheterization which reveals normal coronary arteries and a left ventricle that appears globular with a rounded apex. 

The patient is transferred to the coronary care unit for observation, and several hours later, she becomes progressively hypotensive, tachycardic, and uncomfortable.

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