Cardiology Case Report: Palpitations and Chest Tightness

Our latest case report from Brady Pregerson, MD, features a man in his mid-20s presenting to the emergency department for palpitations and non-radiating chest tightness. Can you determine the correct diagnosis?

History: A man in his mid-20’s comes to the ED for palpitations and non-pleuritic, non-exertional, non-radiating chest tightness on and off for days lasting hours at a time. He also feels anxious. He denies syncope, palpitations, SOB, fever, cough, or other complaints. He states when he goes hiking he feels fine, but when he is trying to fall asleep he notices the palpitations and tightness the most. He denies any tobacco or drug use.

Exam: Vital signs are normal as is his physical exam.

An EKG is performed

What is the most likely cause of the EKG findings in this patient?