The Heart of the Matter: A Supraventricular Mystery

May 10, 2026

A 61-year-old male with a history of asthma and opioid use disorder presented to the emergency department with acute worsening of shortness of breath, chest pain and cough associated with blood tinged sputum for two weeks. The patient also endorsed chronic heroin use; last use was 1 bag of heroin around 24 hours prior to presentation. The patient denied use of anticoagulation, prior DVT or PE, travel, recent surgery, or known cancer history. The patient's initial EKG (Figure 1) is shown below (0224).

Veronica Gonzalez MD, Michael Hohl MD, Erica Dolph MD, Abish Kharel MD, & Ari Edelheit MD

Pharm & Cheese: A Case of Intractable Emesis

May 10, 2026

We start this Wednesday’s Pharm and Cheese off with something unappetizing: emesis. You’re rounding on Red Team and meet a patient with a history of cholangiocarcinoma on chemotherapy who isn’t tolerating PO pending a CT scan. He has normal vitals and a benign exam, but he tells you that for the past two weeks he’s had intractable emesis, even when not eating or drinking. He initially thought it was just from chemo, but his last round was 3 weeks ago and he hasn’t improved.

Samson Frendo MD and Eric Leser MD

The Heart of the Matter: Acute Pericarditis

May 10, 2026

44-year-old otherwise healthy male presents to the emergency department with chest pain. The pain started yesterday mid-day and is described as central and substernal with radiation across the chest and up into the throat. The patient also reports shortness of breath worse with deep breathing and exertion. The patient is incarcerated but otherwise has no historical risk factors for tuberculosis, pulmonary embolism, or cardiac disease. An EKG (Figure 1) is obtained.

Michael Hohl MD and Ari Edelhiet MD

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