A 63-year-old male patient with a history of hypertension, type 2 diabetes mellitus, prostate cancer and class two obesity was admitted for altered mental status and hypertensive emergency. During his hospital stay he developed narrow complex tachycardia and it was difficult to definitively diagnose the underlying arrhythmia. Observation of the cool down phenomenon on electrocardiogram allowed us to make the diagnosis of atrial tachycardia and elegantly ruled out other causes on the differential. We report this interesting case of narrow complex tachycardia.

A 52-year-old female was admitted to rule out an acute coronary syndrome.Her Troponin, ECG, MPS were negative. Further testing she was found to have extremely high high-density lipoprotein level of 218 mg/dl.Due to the persistent nature of the chest pain, LHC was done with 50% stenosis of RCA.

A 43-year-old female patient presented with large bilateral pulmonary emboli. During patient's stay, a fleeting episodes of bradycardia and hypotension with drop in systolic pressure over 40mmHg on slight movements were noted.Being in a rural hospital, patient was transferred in which following that she was pronounced dead relating her presentation.

An 88-year-old male patient with no significant medical history presented with nausea, vomiting and hypothermia. He was admitted for further testing which revealed elevated CK-MB and Troponin with no significant electrocardiogram changes.He denied cardiac symptoms or any previous cardiac history.We share this rare case of hypothermia induced elevation of CK-MB.