Case Presentation: 78 year old woman with persistent non valvular atrial fibrillation was admitted with palpitation and dyspnea. She was in atrial fibrillation with rapid ventricular rate. Given symptomatic atrial fibrillation after rate control, decision was made for transesophageal echocardiogram (TEE) and elective direct current cardioversion (DCCV). She was successfully converted to sinus rhythm with […]

Case Presentation: Patient presented to the ED in June 2019 with 6 month history of progressive proximal bilateral upper and lower extremity weakness, swallowing difficulty and 100 lbs. weight loss over 3 months. Exam was significant for decreased strength of bilateral hip flexors, knee flexors and knee extensors with intact reflexes. Labs were significant for […]

Case Presentation: As physicians, we frequently engage patients and families in goals of care discussions in the context of advanced serious illnesses. These discussions can be challenging for numerous reasons. We present an atypical case of a woman, who experienced acute onset of confusion, numbness, pre-syncope, chest pain, and abdominal pain, after initiating a discussion […]

Case Presentation: Patient is a 29 year old female with no significant past medical history who presented to our hospital with an unintentional 60 pound weight loss over 3 months and 4 days of palpitations, shortness of breath, leg swelling, and orthopnea. Physical exam revealed 4+ pitting edema, tachycardia (130 beats/minutes) and jugular venous distention […]

Case Presentation: Patient is a middle-aged African-American female with a history of hypertension and hyperlipidemia, for which she had been on atorvastatin for approximately four years. She originally presented to her primary care physician for evaluation of a one month history of progressive myalgias and proximal muscle weakness. Creatine phosphokinase (CPK) level was elevated to […]

Case Presentation: A 51-year-old Caucasian male presented for evaluation of worsening lower extremity muscle weakness and associated myalgias. He received a diagnosis of NAM after three months of progressive proximal, symmetric upper and lower extremity weakness with myalgias, and an initial creatinine kinase (CK) of 13,875 IU/L. He had been on Atorvastatin 40 mg for […]

Case Presentation: Vaping-induced organ injuries are increasingly seen in the clinical setting, as the use of vaporizers to smoke tobacco and marijuana has risen almost 150% in the past several years [1]. Cardiotoxicity from vaporizer use has not been reported, and thus the incidence of this phenomenon is unknown. Regular assessment of cardiac function may […]

Case Presentation: A 27-year-old female with a history of PTSD, anxiety, and tobacco use initially presented to the emergency department with the worst headache of her life. Labs were significant for white blood cell count of 18.8 (normal 4.3 – 10.8 x 109 cells/L), troponin of 2.91 (

Case Presentation: A 37 year old man with history of alcohol abuse presented to the emergency department for a one month history of jaundice, nausea, vomiting and weight loss. Physical exam was significant for mild diffuse abdominal tenderness and jaundice. Labs were remarkable for a total bilirubin of 34.1, direct 17.5, alkaline phosphatase of 203, […]

Case Presentation: A 56-year-old female presented to the ED complaining of epigastric abdominal pain for 5 days. Her past medical history was pertinent for a prior left upper extremity DVT. Her family history was positive for Factor V Leiden deficiency, for which she previously tested negative. She denied any pain radiation, nausea, vomiting, or change […]