Young previously healthy man with recent behavioral changes who presents with severe chest pain, signs of autonomic overactivity (tachycardia, hypertension, diaphoresis), rapid and pressured speech and ST-elevations on ECG, most consistent with substance-induced MI (most likely cocaine)
Key idea: In contrast to bipolar disorder (which can also lead to pressured speech, increased activity, etc.), substance-induced behavioral changes will also lead to pure physical manifestations of autonomic overactivity (hypertension, tachycardia, mydriasis, etc.)
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