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Case Study: 31-year-old female with cardiac arrhythmia

History of present illness: A 31-year-old overweight Caucasian female presents post-emergency room with sporadic bursts of increased heart rate while at rest. She reports that it was discovered incidentally during an urgent care visit for a sore throat. She notes two staff nurses unsuccessfully attempted to measure pulse using a pulse oximeter and then attempted manual methods, but said that the rate was too fast for them to read. After slowing down enough for the pulse oximeter to function, heart rate was at 260. Patient was given an EKG and then referred to the emergency room. The EKG taken at urgent care as well as in emergency room showed an inconsistently abnormal P wave or an abnormal QRS wave, which was either reduced or heightened. A full cardio work-up including echocardiogram and stress test came out negative. She is otherwise healthy. Patient denies any recent illness, weight loss or gain, and changes in stress level or activity level.

Social history: Patient denies tobacco use. She denies alcohol and illicit use. She is single. She is self-employed in marketing. She has a dog.

Allergies: Soy.

Past medical history: Pseudotumor cerebri.

Medications: None.

1. How would you monitor this patient, moving forward?

  • Needs EP studies
    March 07, 2020
  • Holter monitoring and blood work such as thyroid function test.
    March 10, 2020
  • Immediate slowing of heart rate in ER with Carotid sinus massage, vagal manuevers, beta blockers, ca channel blockers and or cardioversion. Once stable then definitely holter and EP study
    March 10, 2020
  • Holter Echo
    March 10, 2020
  • Consider event monitor, ep studies and blood and urine drug screening
    March 10, 2020
  • Holter monitor and blood work
    March 10, 2020
  • Start with a Holter monitor, echo, an full labs to include thyroid panel and drug screen. I would make sure that I specifically inquired about herbal supplements and any weight loss medications/supplements (which often can be stimulants that cause arrhythmias).
    July 08, 2020
  • resting ekg, Zio patch, labs (cbc, electrolytes, renal function, tsh, glucose),echo, refer cardio
    August 22, 2020