The Heart of the Matter - A Case of Vaginal Spotting

November 8, 2024

A 64-year-old female with a past medical history of hyperthyroidism status post partial thyroidectomy on levothyroxine initially presented to urgent care for two episodes of vaginal spotting over the last two weeks. At urgent care, she was noted to be tachycardic to the 130s bpm and was thus instructed to go to the Emergency Department (ED). The patient reported left lower quadrant pain but denied any chest pain, shortness of breath, or fevers. An ECG was obtained on arrival.

Authored by Taylor Wahrenbrock, MD, Michael Hohl, MD, and Ari Edelheit, MD.

**Figure 1.** Index point-of-care echocardiogram.

A Case of Cardiac Tamponade Secondary to Malignant Effusion

October 11, 2024

A 40-year-old man with no known past medical history presented with one week of fatigue and dyspnea on exertion. In the last week, the patient developed significant shortness of breath with only a few steps. The patient reported an unintended weight loss of 25 lbs in the last two months, as well as one month of intermittent epigastric abdominal pain and associated nausea. In the last week, the patient was seen by an outside clinic and diagnosed with H. pylori and started on treatment for H. pylori. He denies any other acute complaints or symptoms including orthopnea or paroxysmal nocturnal dyspnea.

Alejandro Ruiz, MD

The Heart of the Matter - ED Referral for Hypertension

September 27, 2024

A 68-year-old female with a past medical history of untreated hypertension was referred to the ED from an outside clinic for hypertension. She had been off antihypertensive medications for several months and had attempted to re-establish care with a PCP but was referred to the ED for a blood pressure of 200/120. At triage, she denied any symptoms. An ECG was obtained at 15:22, when the patient was asymptomatic.

Iris Lawson-Seebaran, DO

the County Consult