Chest pain in 55 M | Figure 1

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Chest pain in 55 M

55yo male pt presents to the ED with complaint of sudden onset 'crushing' chest pain that radiates to left arm and neck. pt stated that when he called 911 his BP was 220/150 with 10/10 chest pain. upon ems arrival, pt BP 180/95, upon arrival to ED BP 135/85. pt was given 324mg ASA and 2 sprays nitro by ems enroute to ED. upon arrival to ED, chest pain 3/10. 12 lead ekg shows NSR with no abnormalities, troponin neg x3, cbc, cmp all WNL. CTA of chest shows no AAA, no other abnormalities. in ED, pt had another episode of increasing chest pain, this appeared to be associated with a small increase in BP from 122/82 to 138/90. pt was given a repeat 12 lead ekg which showed NSR and a nitro patch was administered. pt was admitted for further workup. treadmill stress test negative.

PMH: hypertension on ace-I QD (per pt, BP was well controlled prior to this event), manic depressive disorder on clonazepine QD, denies hx of chest pain or similar episodes, denies recent use of antihistamine

What is causing the chest pain?

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Patient in late teens presenting after a collapse, no chest pain, no previous cardiac history, no history of sudden death in family, are there any features in this EKG that would warrant further work-up or is this just a pediatric EKG?