A 57-Year-Old Female with Cardiological History and Shortness of Breath

A 57-Year-Old Female with Cardiological History and Shortness of Breath

The patient is a 57-year-old female with a history of coronary artery disease, congestive heart failure, and left ventricular thrombus on warfarin who presents with shortness of breath. She denies any bleeding, bruising, dark-colored stools, chest pain, fever, cough, or leg pain. On evaluation, the patient’s vital signs are normal. She is breathing comfortably and speaking in complete sentences. View the ECG and consider what your next steps and diagnosis would be. Resolution of the …

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A 70-Year-Old Female with Nonradiating Chest Pain

A 70-Year-Old Female with Nonradiating Chest Pain

A 70-year-old female with history of coronary artery disease presents to urgent care with nonradiating chest pain of 2 days’ duration. She has a known history of left bundle branch block.               Baseline ECG: View the ECG taken and consider what your diagnosis and next steps would be. Resolution of the case is described on the next page. (Case presented by Benjamin Cooper, MD, McGovern Medical School, Department of Emergency Medicine, The University of Texas …

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A 38-Year-Old Female with Abdominal Pain and Chest Tightness

A 38-Year-Old Female with Abdominal Pain and Chest Tightness

A 38-year-old female with no past medical history presents to an urgent care with right upper quadrant abdominal pain and chest tightness, worsening for 1 week. She reports that her chest tightness is associated with shortness of breath, and is worse when walking and lying on her side. She denies fever, cough, dysuria, headache, or weakness. View the ECG and consider what your diagnosis and next steps would be. (Case presented by Catherine Reynolds, MD, …

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Taking Care of the First Responders Who Take Care of You, Your Staff, and Your Patients

Taking Care of the First Responders Who Take Care of You, Your Staff, and Your Patients

We’ve all seen painful reminders (or experienced them ourselves) of just how helpless natural disasters can leave us. We’ve also been touched and inspired by the bravery and selflessness of first responders—firefighters, police, EMS, and search & rescue personnel—who come to the aid of people in need regardless of their own circumstances. West Virginia University Occupational Medicine is saying thank you by offering a free physical exam for a day at select locations to all …

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ECG Challenge: A 73-year-old Male with Concerns About His Pacemaker

Urgent message: Identifying the most likely cause of a 73-year-old male’s sensation that his heart is “missing beats” — while being mindful of the most potentially serious sources—will guide decisions on the right course of action. The ECG you order will offer invaluable clues as to the appropriate steps to take. By John F. O’Brien, MD The patient is a 73-year-old male who presents with a primary complaint that it occasionally feels as if his heart is “missing …

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37-year-old diabetic female feeling weak after switching diuretics

37-year-old diabetic female feeling weak after switching diuretics

The patient is a 37-year-old female who presented with a history of longstanding hypertension and diabetes mellitus. She had recently started on a new diuretic, and felt very weak and lightheaded. Her blood pressure was 88/56 mmHg with a pulse of 44 beats per minute. After reviewing the ECG, consider the following questions: 1. Based on this ECG, what type of diuretic is she likely to be taking? 2. How should she be managed?

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32-year-old male with burning sensation in chest

32-year-old male with burning sensation in chest

The patient is a 32-year-old male who woke up at 1 a.m. with a burning sensation in the mid-chest (a first-time event, he reports). The patient is not diaphoretic, and has no dyspnea. He is generally healthy and has no known risk factors for heart disease. His physical exam is unremarkable. In addition, you find: BP: 154/102 Pulse: 68 Sat: 99% Temperature: 97.3 °F View the EKG taken and consider what your diagnosis and next …

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