Background: Compared with health care systems globally, the U.S. health care system expends more resources yet achieves worse patient outcomes. Growing recognition that such low-value care is a system-level problem has spurred efforts to optimize system-level processes. Low-value hospital admissions are a major contributor to overall low-value care, but limited descriptions of specific processes for [...]

Background: Syncope is characterized by a transient loss of consciousness, with vasovagal syncope being the most common cause. According to the American College of Cardiology (1), routine cardiac imaging, including transthoracic echocardiography (TTE), is not recommended in the evaluation of syncope unless there is a clinical suspicion of a cardiac cause, based on the patient’s [...]

Case Presentation: A 32-year-old female with focal epilepsy presented with several episodes of drop attacks with associated loss of consciousness (LOC). There were no witnessed tonic-clonic movements or prolonged post-event confusion. There were no prodromal symptoms including chest pain, palpitations, or features of increased parasympathetic tone. Vital signs and physical exam were normal. Initial electrocardiogram [...]

Case Presentation: A 36-year-old woman with a past medical history of postural tachycardia syndrome (PoTS), seizure disorder, left ICA aneurysm status post embolization, presented due to short 30-second episodes of syncope with concurrent hypotension and bradycardia for the past few years. The patient had multiple episodes of bradycardia and hypotension requiring pressors. The physical exam [...]

Case Presentation: A twenty-six year old female was admitted for further evaluation after a Transthoracic Echocardiogram (TTE) showed three cardiac masses in the left and right atrium. Initial symptoms included near syncopal episodes, exertional dyspnea and fatigue. Further history revealed that the patient had right tonsillar swelling with some difficulty swallowing two months prior to [...]

Case Presentation: A 25-year-old female with no significant medical history presented with recurrent syncope, reporting no use of medications, stimulants, alcohol, or illicit drugs, and no family history of cardiomyopathies or sudden cardiac death. Her first syncopal episode in December 2020 occurred suddenly, without prodromal symptoms, followed by two more episodes in 2021 and 2022, [...]