Theodore Chan, MD


Middle-Aged Man With Light-Headedness, Nausea, and Palpitations

November 01, 2007

A 44-year-old man presents to the emergency department (ED) with light-headedness, nausea, and vomiting of 1 day's duration. He has also had intermittent palpitations but denies chest pain, dyspnea, and weakness.

Normal Sinus Rhythm With Junctional Escape Beats: ECG Findings

September 01, 2007

A 68-year-old woman with hypertension complains of intermittent dyspnea and light-headedness. She is asymptomatic during the evaluation. Vital signs are normal, but an irregularly irregular pulse is noted on examination as well as on the telemetry monitor. The 12-lead ECG is shown here; the ECG machine printout reads "atrial fibrillation." The patient has no history of this arrhythmia.

Weakness in a Young Woman

April 15, 2007

A 24-year-old woman presents to the emergency department (ED) withgeneralized weakness, headache, and muscle cramping that have progressivelyworsened over the past week. Recently, she has also had nauseaand vomiting. She denies chest pain, palpitations, dyspnea, cough, fever,chills, diarrhea, and urinary symptoms. She has a history of type 1 renaltubular acidosis.

Discordant ECG Findings in a Man With Chest Pain

February 01, 2007

An 80-year-old man presents to the emergency department (ED) with intermittent dyspnea and chest pain. He has hypertension and osteoarthritis but no known cardiac disease. Vital signs are normal. No jugular venous distention is noted. The lungs are clear with equal breath sounds, and the heart rate is regular, without murmurs, gallops, or rubs. The chest wall is not tender. No edema or asymmetry is evident in the extremities.

A Tale of Two "Pulseless Electrical Activity" Cardiac Arrest Rhythms

January 01, 2007

In cases of PEA, a rapid, narrow-QRS-complex rhythm is associated with an improved chance of survival.

Man With Persistent Chest Pain and ST-Segment Depression

December 31, 2006

A 54-year-old man with a history of type 2 diabetes, hypertension, and coronaryartery disease with angina presents to the physician’s office withchest pain. The pain began 3 hours earlier and is associated with diaphoresisand dyspnea. Examination results are unremarkable, except for diaphoresis.A 12-lead ECG reveals normal sinus rhythm with large R waves and horizontalST-segment depression in leads V1 through V3. The patient is given nitroglycerin,aspirin, heparin, morphine, and a &#946-blocker for noninfarction acutecardiac ischemia and transferred to the local emergency department (ED).

Near-Syncope in an Elderly Woman

December 31, 2006

An 84-year-old woman with hypertension and type 2 diabetes mellitus isbrought to the emergency department (ED) after an episode of nearsyncope.When emergency medical service personnel initially assessed her,blood pressure was 96/60 mm Hg and heart rate was “slow”; however, shehad no symptoms.

Middle-aged Man With Chest Pain After Exercise

December 31, 2006

A42-year-old man with a history of hypertension presents to an outpatientclinic with chest pain that began the day before, after he had worked outat his health club. The discomfort increases when he walks and worsenssomewhat with inspiration. No associated symptoms are noted. Results of aphysical examination are normal; no chest wall tenderness is evident. Becausecertain features of the presentation suggest an acute coronary syndrome, a12-lead ECG is obtained, which is shown here.

Chest “Tightness” in an Elderly Woman

December 31, 2006

A 76-year-old woman presents with chest pain-which she describes as“muscle tightness”- that began when she awoke in the morning. Thepain is constant, exacerbated by deep inspiration, and accompanied by asubjective sense of slight dyspnea; she rates its severity as 3 on a scale of1 to 10. She denies pain radiation, nausea, diaphoresis, palpitations, andlight-headedness. Her only cardiac risk factors are hypertension and a distanthistory of smoking.

A 30-year-old man complains of chest pain, dyspnea, fever, and nonproductivecough that began earlier in the day

December 31, 2006

A30-year-old man complains of chest pain, dyspnea, fever, and nonproductivecough that began earlier in the day. The pain is constant and does notdiminish with rest; it worsens somewhat with deep inspiration and has localizedto the left chest. The patient has had no nausea, vomiting, or abdominal pain.He has been immobile for several years secondary to spinal cord disease buthas no history of cardiopulmonary disease.