Case Presentation: A 64-year-old Caucasian female patient with no significant medical history came to medical attention in December 2016 with an episode of generalized tonic clonic seizure. On admission, review of systems, vital signs and physical examination were unremarkable. The following laboratory tests were normal or negative: complete metabolic panel, complete blood count, urinalysis, chest [...]

Case Presentation: We present the case of a 32-year-old woman with past medical history of anxiety/depression, previous heroin abuse, hepatitis C who presented with tremors, chest pain, and vomiting. In the ER, her vitals were HR 94, RR 22, BP 117/83, SpO2 95% on room air. Initial labs showed elevated troponin 1.38, 4.44, 9.15. EKG [...]

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: 78-year-old female with a past medical history of diabetes, hypertension, and vascular dementia was brought to the hospital by her family for worsening dementia, behavioral disturbances including agitation, insomnia, hallucinations and delusions. Her lab workup showed hemoglobin of 11.5 g/dl, troponin of 0.09 ng/ml, CK of 88 u/l, CK-MB of 2.25 ng/ml. Electrocardiogram [...]

Case Presentation: A 21 year old Caucasian female with an unremarkable medical history presented with sudden onset of throat, lip and tongue angioedema. Due to concern for complications, she was given intravenous (IV) diphenhydramine, solumedrol and epinephrine (0.3mg of 1:1000 concentration). Patient developed acute hypoxic respiratory failure and hypotension. She required mechanically assisted ventilation and [...]

Case Presentation: A 47-year-old African American female with a past medical history of complex regional pain syndrome (CRPS), chronic migraines, and history of transient ischemic attack was admitted for elective lidocaine infusion for generalized pain secondary to CRPS. On hospital day four of infusion, the patient developed substernal chest pain and shortness of breath. An [...]

Case Presentation: A 36 years old female with past medical history of IV drug abuse, presented with dyspnea, nasal congestion, tactile disturbances, diarrhea, body aches and generalized weakness for 1 day. She was recently treated for tricuspid valve endocarditis. A Transthoracic Echocardiogram (TTE) obtained at that time showed ejection fraction (EF) of 55-60%. On presentation, [...]

Case Presentation: A 68-year old female with a history of uncomplicated alcohol dependence was brought in by ambulance after a witnessed seizure at home characterized by myoclonus for several minutes and prolonged post-ictal confusion. Upon presentation, she was altered, hypertensive to 183/118, and had a supraventricular tachycardia to the 160s broken with adenosine. The patient [...]

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: Our patient is 78-year-old female with a history of mitral regurgitation, left ventricular outflow tract obstruction (LVOT) with systolic anterior motion (SAM) of mitral valve, migraines, and hypertension presented with lightheadedness. She had increased blood pressure at her recent office visit few weeks back necessitating an increase in dosage of verapamil. At presentation, [...]