Cardiology Case Report: 3 Days of Episodic Chest Pain

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This cardiology case report from Brady Pregerson, MD, features a man in his late 50s presenting with 3 days of episodic chest pain. Can you determine the correct diagnosis?

History of Present Illness:

A man in his late 50’s presents to the ER with 3 days of episodic chest pain, both at rest and with exertion. He has been getting it 2-3 times a day lasting about 5 minutes at a time until today when it became more severe and lasted about 10 minutes. In addition, today it radiated to his left arm for the first time. His modifiable cardiac risk factors include tobacco use and hypertension.

Vital Signs & Physical Exam:

Vital signs are normal. Physical exam is also normal. He is currently pain free

An ECG is Done:

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