A 43-year-old athletic black male was awoken from sleep with severe left-sided, nonradiating chest pain. He has no past medical history and denied any recent injury, infection, or drug use. He described the chest pain as nonreproducible on palpation but sharp that increased in severity when laying on his left side. Because of his symptoms the patient went to the local emergency department. On a...

A 44-year-old woman presented to her local emergency room with a 1-day history of nausea, fatigue, and fever of 101°F. At that time, she denied chest pain, dyspnea, cough, orthopnea, or lower-extremity edema. An ECG was reportedly normal, and she was treated with antiemetics and fluids and discharged home. The next day, she developed persistent, aching pain in her chest and jaw and presented to...

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, lifethreatening syndrome of excessive multisystem inflammation and tissue destruction due to abnormal immune activation. It is more frequently seen in the pediatric population, either as a genetic disorder or secondary to infection or autoimmune disease, but can present in acquired forms at any age. It is thought to be due to an absence of dow...

An obese but otherwise healthy 53-year-old man was unloading a delivery van when he was struck from behind by a slow-moving garbage truck, pinning him between the 2 vehicles. The patient was lying supine on the ground when emergency medical services arrived. He was alert and oriented with a Glasgow Coma Scale score of 15. The patient was complaining of pain in his right upper extremity and numb...

258 A 73-year-old white woman presented to a community hospital emergency department with 7 days of productive cough, dyspnea, and fatigue. Her vital signs were as follows: temperature, 99.9°F; pulse, 100 bpm; respiratory rate, 16 breaths per minute; blood pressure, 153/78 mm Hg; and oxygen saturation, 97% on room air. Her jugular venous pressure was normal; her lungs were clear; and her cardia...

A previously healthy 26-year-old man presented to a community hospital with a 1-week history of malaise, dyspnea, and cough productive of clear sputum. He also had intermittent lower abdominal pain for the preceding 5 days. He was otherwise healthy and not taking any medication. He was an ex-smoker with a 7-pack-year smoking history who quit 2 years ago, rarely drank alcohol, and denied using a...

A 63-year-old white male was admitted with recurring chest pain of increasing intensity for ≈3 days. He had a known history of arterial hypertension and was obese, with a body mass index of 29.4 kg/m2. After seeking help at his family physician he was immediately transferred to our hospital using emergency medical services because of ST-segment elevations. On arrival he had severe chest pain wi...

A 21-year-old man with a history of Ebstein anomaly and atrial fibrillation who had previously undergone tricuspid valve repair, pulmonary venous isolation, and the Cox maze III procedure was referred from an outside institution for the evaluation of an acute onset of left-sided upperand lower-extremity weakness. The patient had initially presented 3 years earlier with abdominal pain and sympto...

A 61-year-old man presents with 2 weeks of exertional dyspnea. Pertinent medical history includes hypertension, nephrolithiasis, and internal hemorrhoids. He takes no medications and has no known drug allergies. His father died after a myocardial infarction at 57 years of age. He formerly smoked 1 pack of cigarettes daily for 15 years but ceased tobacco use 10 years before presentation. He inge...

A 25-year-old white woman was referred to the outpatient cardiology clinic at our institution for a second opinion regarding a newly diagnosed cardiomyopathy. She was in a normal state of excellent health, without a significant past medical history, when she began to develop exertional fatigue, dyspnea, orthopnea, and paroxysmal nocturnal dyspnea. Her primary care provider diagnosed her with pn...