EKG Challenge #5: Chest Pain So Bad I Fell Out

A middle-aged woman with no significant medical history presents after a syncopal episode.  She is now complaining of shortness of breath and chest pain that radiates to her shoulder and jaw.  She has no other pertinent history besides being a smoker and her father having a myocardial infarction at an early age.  Her vitals are initially stable, but she soon becomes tachycardic and hypotensive.  Her labs are drawn and her ECG is below:

What is your differential diagnosis?  What would you do next?

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