I had a case tonight and was looking for some opinions. It may be a little long, so feel free to stop reading here. 37 y/o guy comes in c/o "crushing" left sided chest pain. Woke him up a few times during the night before. Was present in the am when he woke up got better (did not go away) during the day. Got worse in the evening and developed some sob, nausea and fatigue, which is why he finally came in. He was seen 1.5 weeks prior for the same. Initial troponin was negative and signed out AMA at that point. Has had pain on and off since then. Not brought on by anything. No PMH. FH significant for father with an MI in his 30s and maternal grandfather and maternal uncle with MIs in their 40s. 1.5ppd smoker, no drugs or EtOH. EKG shows NSR at 70bpm. Small Q waves in 2,3,F,V4-6 which were present on EKG from previous ER visit. cxr normal. Gave him the ntg and ASA with some relief. He got his 1st lopressor without a problem. He got about 1 mg of the second dose (15 minutes after the first) and started to brady down. The nurse calls me in at this point. He's pale and diaphoretic with a HR of 37 and BP 122/65. Nurse lays him down and starts to give some fluid as I come in. Lets out a gasp and becomes unresponsive. Monitor shows asystole. Has about a 10-15 sec run of asystole. Without intervention, other than shaking him and calling his name, his heart starts again with a rate in the 30s. He gets some glucagon and atropine which brings him up to the 60s. Still looks like hell warmed over but conscious and feeling better. Color came back and vitals remained stable. To make a short story long, we were talking about it after. Some thought the asystole was from the lopressor while others thought it may have been something more sinister. Any opinions? PS- Sorry it is so incoherent and rambling but I'm on overnight #6.