A 33 yo F with no other past medical history other than bilateral Bell’s palsy that resolved years ago presented to the ED, as she was found down, unconscious near a café.

She was successfully resuscitated after requiring emergency treatment for sudden cardiac arrest.

Echocardiogram revealed severe biventricular failure with inferior posterior septal wall motion abnormality. A heart catherization was performed, which showed mild non-obstructive coronary artery disease.

What is the next best step?

  1. Monitor on telemetry
  2. Start aspirin
  3. Obtain cardiac MRI
  4. Call cardiac electrophysiology consult
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A 37 yo F with hx of well-controlled asthma on albuterol prn presented to the ER with an erythematous, nonpruritic, painful, nodular rash of 1 week’s duration on her legs and new onset of joint pain. Two days prior to her ER visit, she noted bilateral, left greater than right, ankle pain, redness, and swelling. She was afebrile with normal heart rate, blood pressure, and oxygen saturation on room air.

Physical exam was notable for erythematous painful nodules scattered on her lower legs. Ankles had full range of motion with erythema and diffuse soft tissue swelling. No effusion was palpated in the ankle joints. Laboratory data revealed elevated inflammatory markers but normal calcium, creatinine, and LFTs. Telemonitor did not show any arrhythmias.

What is the next best step?

  1. Start corticosteroids
  2. Discharge patient with dermatology and rheumatology follow-up
  3. Obtain baseline chest x-ray
  4. Obtain baseline EKG
  5. Obtain 1,25 OH vit D levels
  6. Obtain ankle x-rays
  7. If arthritis and/or skin lesions (that seem characteristically erythema nodosum) do not resolve with course of steroids, consider options for second-line therapies
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