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

Heart of the Matter: A Difficult Case of Atrial Tachycardia

April 22, 2026

The patient is a 52-year-old female, with a past medical history of hypertension, congestive heart failure, atrial fibrillation on rivaroxaban, and type 2 diabetes who is presenting with palpitations and shortness of breath for two days. Episodes last 1-3 minutes at a time before resolving. She has a history of similar symptoms the month prior, for which her cardiologist recommended an ablation in the future.

Emily Bovasso MD and Ari Edelheit MD

Heart of the Matter: A FoCUSed Diagnosis

January 31, 2026

A 38-year-old male presents to a community hospital emergency department at 3 a.m. and a rapid response is called to the front of the hospital. You respond, and the patient is alert but diaphoretic, weak, and displaying Levine’s sign (a fist clenched over his chest). His wife states that the chest pain started about 30 min prior to arrival. The patient is brought to your resuscitation bay, and his vital signs are as follows: BP 145/98, HR 99, RR 18, O2 93%. You ask for an EKG when then tech informs you that both of the EKG machines in the ED are broken, and we currently have no way of obtaining a tracing. What do you do in this scenario?

Michael Hohl MD, David Murray MD, and Ari Edelheit MD

the County Consult