A 79-year-old female with hypertension, CKD Stage 4, history of breast cancer s/p tamoxifen therapy, osteoporosis presenting to the emergency department for pleuritic chest pain radiating to back. Laboratory work-up is significant for a troponin of 0.24, a d-dimer of 2.40., and a creatinine of 2.4 (baseline 1.8). The plan is for the patient to be admitted to medicine for V/Q scan to evaluate for pulmonary embolism. The patient’s EKG (Figure 1) is shown below.

Michael Hohl, MD and Ari Edelheit, MD

The Case:

A 62-year-old F with a PMHx of osteoarthritis presented for two months of intermittent, unprovoked syncope, worse over thepast 24 hours. She was admitted one month prior and had TTE and 24 hours of observation without a noted event. She notes the day prior syncopizing without prodrome, chest pain, or SOB, and additionally experienced this 1-2 hours prior to presenting. She was brought to resus after syncopizing in the waiting room and being bradycardic. Figure 1 was obtained when the patient initially presented to the resus bay.

Jose Reyes, MD