A 32-year-old man presents to the emergency department with severe, crushing substernal chest pain that began 45 minutes ago. He reports feeling "heart racing" and extreme anxiety. He admits to intranasal cocaine use approximately one hour prior to the onset of pain. He has a history of tobacco use (1 pack per day) but no other known medical conditions. He denies any family history of premature coronary artery disease. He is visibly agitated and diaphoretic.

He is afebrile. His blood pressure is 165/100 mmHg with a heart rate of 118 bpm. His respiratory rate is 22 breaths/min, and oxygen saturation is 98% on room air. He is anxious, restless, and diaphoretic. He is alert and oriented x 3.