A 45-year-old man presented with sharp, left-sided chest pain of one-hour duration that radiated to the right chest and back, and started two hours after snorting cocaine. He was an active smoker and his medical history included pulmonary embolism on anticoagulation, heart failure with reduced ejection fraction of 9% with an implantable cardioverter-defibrillator, and cocaine use disorder. Vital signs were normal, except for a respiratory rate of 20 breaths per minute. Laboratory examinations were unremarkable, and an electrocardiogram was unchanged when compared to previous ones.
