A 62 year-old African American female with past medical history significant for scleroderma, Raynaud’s phenomenon, and hypertension presented to the ED with 6 weeks of worsening fatigue, shortness of breath and a new onset of left sided chest pressure. Her outpatient medications included metoprolol 50 mg every 12 hours and nifedipine XR 90 mg once daily. On physical examination, the patient was noted to have a blood pressure of 189/62 mmHg and a pulse of 44 beats per minute. Her laboratory data including chemistry panel, complete blood count, and cardiac enzymes were unremarkable.