Ischaemia sparked by stress

A 74-year-old woman with a history of hypertension, no history of coronary disease and a permanent pacemaker for conduction system disease was evaluated by her cardiologist recently and everything seemed to be in order, including a recent echo, pharmacological nuclear perfusion test and pacemaker check. She called an ambulance after feeling the sudden onset of shortness of breath and chest tightness one morning after hearing some distressing news about the untimely death of a good friend. Ambulance officers found her to be diaphoretic and looking unwell and she was emotionally distressed. An ECG was taken and is shown above. She was given oxygen, Anginine, aspirin and morphine and was brought to a local hospital emergency department. 

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