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

A 50-year-old male with a history of tobacco use disorder presents with 1 week of intermittent, central, pressure-like chest pain that lasts a few minutes at a time without clear exacerbating or relieving factors. He had a particularly severe episode just before arrival but is now pain free. The initial ECG is shown in Figure 1.

Samson Frendo, MD and Adam Roussas, MD

The Case:

A 72yo M presents via EMS for chest pain that started while chopping wood. Initially, an ECG was sent by EMS en route with concern for ST-segment elevation. 324 mg PO aspirin and 400 mcg of sublingual nitroglycerin were administered prior to arrival. Vitals per EMS were notable for bradycardia and hypotension.

Stewart Pine, MD