Background: Inpatient stewardship has appropriately become a large focus of acute inpatient care. The Vizient™ Clinical Data Base contains hospital discharge data used for benchmarking, and we observed significantly elevated cardiac MRI (cMRI) use at our tertiary hospital, relative to other tertiary academic medical centers, with resource utilization percentile averaging in the top decile (figure [...]

Case Presentation: This is a 53-year-old Caucasian female with a history of hypertension, recent stroke, and obesity, who presented with chest pain. She had intermittent chest discomfort as a child and was told she had asthma; however, over the past few months, her chest pressure became more frequent and occurred both with activity and rest. [...]

Case Presentation: A 65-year-old man presented with anasarca and dyspnea on exertion that progressively worsened over three weeks. He had no known cardiac, renal, or liver disease prior to presentation. Physical exam revealed elevated jugular venous distention, bibasilar crackles, tense ascites, scrotal edema, and pitting edema in bilateral lower extremities extending to the abdomen. Investigation [...]

Case Presentation: A 32-year-old man with untreated hypertension for 5 years, presented with 4 hours of sharp substernal chest pain. The pain woke him up from sleep and was present at rest and on exertion. The pain lasted 30 seconds and then decreased in severity, without any identifiable alleviating factors. He received aspirin and ondansetron [...]

Case Presentation: A 24 year-old male presented with rash and fever for one month. He was recently diagnosed with bipolar disorder and started on fluphenazine, lithium, and benztropine. Four weeks after starting these medications he developed a diffuse pruritic rash, intermittent fevers, confusion and lethargy. On evaluation the patient was febrile and tachycardic, with a [...]

Case Presentation: A 76 year-old African American female with no past medical history presented with new onset shortness of breath and substernal chest pressure of three week duration. She noted that she had been previously healthy without any issues prior to this incident. On presentation, the patient was afebrile and normotensive (125/76) but tachycardic (110 [...]

Case Presentation: A 48-year-old female presented with a 1-day history of exertional, non-positional, mid-sternal, severe chest pain associated with nausea, palpitations and dyspnea. She denied orthopnea, ankle swelling, cough, wheeze, coryza, fever, chills, or recent ill contacts. Past medical history: asthma, vertebral artery dissection, hypothyroidism, migraines, and severe acute respiratory syndrome coronavirus 2 (COVID-19) infection [...]

Case Presentation: A 47-year-old African-American man with obstructive sleep apnea presented to the emergency department after being called-back due to evidence of complete atrioventricular (AV) block on routine electrocardiogram. Patient reported a 6-month history of fatigue and exertional dyspnea. On physical examination, he was afebrile and in no acute distress. Vital signs were BP: 142/92 [...]

Case Presentation: A 56-year-old previously healthy Caucasian woman was evaluated by a neurologist for seizure-like activity and syncope. She was placed on a Holter monitor that showed episodes of paroxysmal supraventricular tachycardia, ventricular tachycardia (VT), and third-degree AV block. She presented to the emergency department with chest pain, a new left bundle branch block, and [...]