Hi There, 31 year old healthy female with only past medical history of questionable raynauds phenomenon and 2 miscarriages in the last 6 months. Last one was one month prior to this incident. Recent right upper back pain and shortness of breath. Went to ER. DDimer 3000, CTA was negative for PE, Echo normal EF 57%, Troponins 2 and peaked at 12. Cardiac cath was clean. Cholesterol labs are great. Junctional bradycardia that went back to sinus with lots of PAC s over 3 days. Shocked liver, AST and ALT 300 s. Duplex lower extremities negative for DVT. Cardiac MRI showed infarcts to septum and lateral wall (still waiting on official report, but verbal from cardiologist). Backstory - recent 8 day 125 mile backpacking trip, 40# backpack, elevations 4000-11000. Live at 5000 . Frequently at elevations 10000-14000. Prepared for a year for this trip physically. Physically felt great on trip, symptoms did not start until 30 hours after being off the trail. Some docs are insisting this hike could have caused clots. Temps were 30-70 degrees. GFR, BUN, creatinine were all normal. No signs of dehydration. Hypothesis so far is vasospasms or embolic phenomenon. Any other thoughts or possibilities?? Could this be a PFO or ASD with a paradoxical coronary embolic event?