CT scanning correctly identified all patients with PH with MPADs >34 mm and excluded all patients without PH when MPADs were <27 mm. We advocate that the measurement of MPAD by CT scanning can be quickly and easily performed by the clinician to screen for the presence of PH.

Our study results further validates the ROSE rule and the utility of BNP in risk stratification of syncope patients. This study showed that measuring BNP and adding ROSE rule to the standard evaluation of syncope can sufficiently predict short-term serious outcomes for patients presenting to ED with syncope.

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Macro enzymes are high molecular mass complexes that consist of normal serum enzymes and proteinimmunoglobulins. Creatine kinase (CK) is a muscle enzyme that has three isoenzymes. Two types of macro CK have been described; Macro CK type 1 and macro CK type 2. We report a case where cardiac enzymes were persistently elevated in the absence of myocardial injury. The false elevation was secondary to the presence of macro CK type 1 yielding aberrantly increased CK-MB. Our patient lacked clinical as well as electrocardiographic (EKG) changes to validate myocardial ischemia. Apperception of diagnosing falsely elevated cardiac markers is imperative to avoid unnecessary procedures

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