- A 62-year-old woman presented to an outside emergency department with a 24-hour history of vomiting-associated chest pain. She described a nonradiating retrosternal ache with dyspnea and diaphoresis after multiple episodes of nonbilious and severe vomiting. Recent history was notable for amoxicillin/clavulanic acid–treated colitis. After failure to improve, she was diagnosed as having Clostridium difficile and completed 10 days of treatment with vancomycin. Two weeks prior to presentation, fidaxomicin was initiated because of persistent symptoms and ongoing stool positivity.
- A 33-year-old previously healthy white woman (gravida 1, para 1) who recently delivered a healthy baby girl via elective cesarean section experienced acute shortness of breath approximately 6 hours after delivery. Her pregnancy was complicated by development of preeclampsia without severe features at 32 weeks. Because of her preeclampsia, she underwent elective cesarean section at 37 weeks’ gestation. She received routine prenatal care and was up-to-date on all vaccinations and screenings. Her medical history, social history, and family history were unremarkable.
- An 84-year-old woman presented to the emergency department with an 8-hour history of persistent substernal chest pain. The pain intensity was rated a 6 on a scale of 1 to 10, radiated to the shoulder blades, and was worse with deep breathing and lying flat. She denied dyspnea, orthopnea, palpitations, or lower-extremity edema. She had no history of cardiac disease. Her medical history was notable for well-controlled rheumatoid arthritis and hypertension. Her medications included triamterene and hydrochlorothiazide (37.5 and 25 mg/d) for hypertension and methotrexate for rheumatoid arthritis (15 mg/wk), which she had stopped taking 8 weeks earlier after recent hip surgery.