This patient with history of CHF (EF 10-15%), COPD, presented to the ED with concern for chest pain and dyspnea. She had unfortunately had a recent ischemic stroke with hemorrhagic conversion that left her with speech and communication deficits. EMS was called because she appeared to be pointing to her chest and appeared dyspneic, but further history was limited by her aphasia. EMS noted her to be mildly hypoxic, which improved with oxygen by nasal cannula.