Background: New onset third degree or complete heart block (CHB) is a medical emergency and usually requires permanent pacemaker. CHB can be caused by cardiac ischemia or non-ischemic conditions such as infiltrative diseases or fibrosis. The purpose of this study was to analyze the clinical characteristics associated with ischemic versus non ischemic causes of complete [...]

Background: In 2014, the ACC/AHA released guidelines regarding indications for preoperative transthoracic echocardiogram (pre-op TTE) in patients undergoing noncardiac surgery. Studies indicate that the ordering of pre-op TTE in noncardiac surgery is not consistent with the ACC/AHA guidelines. Some studies suggest the pre-op TTE have a significant impact on management, while others have demonstrated low cardiac [...]

Background: Guidelines recommend in-hospital evaluation with cardiac monitoring and transthoracic echocardiogram (TTE) to assess syncope in patients that are considered high-risk for major adverse cardiovascular events. We sought to identify variables associated with performing TTE in patients presenting with syncope. Methods: We abstracted demographic and clinical data from all patients evaluated for syncope at the [...]

Case Presentation: An 85-year-old female with a medical history of hypertension, hyperlipidemia and tobacco abuse presented to the ED with a several day history of intermittent, non-radiating substernal chest pain that occurred at rest. Physical exam revealed normal vital signs, regular cardiac rhythm, no murmurs or gallops, clear lungs, and no jugular venous distention or [...]

Background: Echocardiography is an essential evaluation in the diagnosis of infectious endocarditis (IE). Transthoracic echocardiography (TTE) is a portable study that is widely available and non-invasive. Though transesophageal echocardiography (TEE) is traditionally known for higher sensitivity and specificity, it is speculated that improvements in modern TTE imaging could produce higher diagnostic yield than previously thought. [...]

Background: Unnecessary hospitalizations and testing for syncope remain common (1), and physician attitudes continue to favor overuse for syncope (2). Structured protocols, specialized units, and decision support algorithms may reduce health service use, but lack of data precludes the ability to advocate for use of a specific decision support algorithm (3). Purpose: Our primary aim [...]

Case Presentation: 60 y/o African American male with h/o chronic esophageal strictures s/p multiple esophageal dilations presented to the ER with complaints of weakness and dizziness. He met criteria for sepsis with possible source as aspiration pneumonia and was started on broad spectrum antibiotics. Two sets of blood cultures done from admission grew Streptococcus mitis/oralis. [...]

Case Presentation: 77-year-old Caucasian male presents to the ER due to progressive shortness of breath impacting his activities of daily activity. Shortness of breath started 2 weeks ago and was associated with a hacking cough and minimal sputum production for which he visited his physician’s office and received a steroid shot for “bronchitis”. On further [...]

Case Presentation: A 73-year-old woman with past medical history of hypertension was discovered unresponsive at home, prompting initiation of CPR during transportation to the Emergency Department, resulting in the restoration of spontaneous circulation (ROSC). A chest x-ray indicated the presence of left-sided tension pneumothorax, necessitating the placement of a chest tube. Initial electrocardiogram (EKG) findings [...]

Case Presentation: A 29 year-old woman with sickle cell disease (SCD) on hydroxyurea and L-glutamine, and mild intermittent asthma presented to our institution with right lower extremity and back pain suggestive of a vaso-occlusive crisis. She did not report fever, cough or dyspnea. Vital signs revealed a heart rate of 91/min, blood pressure of 126/86 [...]