Palpitations<div id="article-content-body"><p>The patient had a normal echocardiogram at age 16 when his father was found to have a bicuspid aortic valve. At age 18, he began experiencing intermittent episodes of sudden tachycardia provoked by strenuous athletics. A formal treadmill exercise test failed to demonstrate any dysrhythmia or ischemia despite a peak heart rate of 199 beats per minute at 12:30 minutes of the standard Bruce protocol. By age 19, he was having episodes about monthly, with a heart rate he estimated to be about 220 beats per minute. He has learned to terminate episodes with the Valsalva maneuver.</p><p class="MsoNormal"> </p></div>
Pain, Chest pain, Chest Pain After Cocaine<div id="article-content-body"><p>A 53-year-old man presents to the emergency department (ED) with chest pain that started the previous night. The pain began about 30 minutes after he had smoked marijuana and inhaled cocaine. He describes the pain as tightness in the left side of the chest that radiates into the neck; he also has a tingling sensation in both the left side of the neck and the left arm.</p></div>
What's Your Diagnosis?A staff nurse calls the physician to see "something really bizarre—we have no idea what this is": the plastic of a urine collection bag of an 81-year-old woman has turned purple, although the urine within is more orange-brown and distinctly less odd looking.