Camilo E. Gutiérrez, MD, FAAEM

Boston Medical Center / Boston University School of Medicine

CASE PRESENTATION

A 17 year old teenager presents as a new immigrant from Haiti for evaluation of “heart murmur” diagnosed there. Has no immediate family with him so past medical or family history is unclear. He is on no medications and denies drug abuse.

Complaints of occasional chest pain, palpitations and shortness of breath.

His vital signs are within normal limits.

On examination patient is noted to be tall and thin, pectus excavatum and high arched feet. Has evidence of scoliosis, fingers are long and thumbs are very lax. Lung exam is normal. Cardiovascular exam is remarkable for a holosystolic murmur with mid-systolic click, heard best at the apex and accentuated by valsalva. Mental status is normal. Neurologic examination is also within normal limits. read more

Andres Bayona, MD, Robert M Lapus, MD

Department of Emergency Medicine, University of Texas Medical School at Houston, Houston, Texas

Children’s Memorial Hermann Hospital, Houston, Texas

CASE PRESENTATION

A one month old girl with a history of congenital complete Atrioventricular (AV) block with an implanted pacemaker placement on day of life 6, presented to the Emergency Department (ED) with rash and fever. One week prior to presentation she developed a rash on her face, which slowly spread to her chest, abdomen and extremities. On the day of presentation she developed a fever at home. Mom brought her to the pediatrician, who then referred them to the ED. read more