A 55-year-old female comes to your ED with complaints of a s…

A 55-year-old female comes to your ED with complaints of a sudden onset of severe substernal chest pain with radiation into her jaw. She is diaphoretic and anxious. She has one episode of vomiting in the ED and continues to be nauseated. Her troponin is elevated at 1.24 (normal > 0.04) VS –   BP: 100/40    P: 78     RR:30      O2 Sat:93% room air (RA) Her initial EKG is below: question46exam3.png Which of the following is on your differential diagnosis?