A 70 year old female with HIV, diabetes, hypertension, COPD/asthma, and CKD3 presents to the emergency department with a complaint of worsening shortness of breath. She believes her shortness of breath is typical of her COPD exacerbation but notes new, intermittent left-sided chest pressure. The initial lab results are significant only for a BNP of 545. The vitals are notable for bradycardia with a rate in the 40s. The patient's initial EKG (Figure 1).

Abish Kharel, MD and Ari Edelheit, MD

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