S:

SS is a 29 yo female with chief complaint of palpitations. She states they have been occurring intermittently for months and she “can feel her heart beating and it is very intense.” During the episodes, her left arm becomes stiff. Admits slight, throbbing chest pain. Denies fever, chills, shortness of breath, fainting, known heart murmur, family history of sudden cardiac death, personal or family history of anxiety disorders. She states the episodes occur more frequently when she is anxious or stressed, and commonly occur when she is trying to go to sleep.

PMH: Uterine Fibroids, Frequent UTI, Frequent Yeast Infections

PSH: Denies

Allergies: Denies

Medications: Levonorgestrel/ethinyl estradiol 0.15mg/30mcg tab

FHx: Unknown

SHx: Admits occasional EtOH and Marijuana Use (1 Marijuana Cigarette/week), Denies Tobacco Use, Illicit Drug Use

O:

T 36.8C | BP 124/84mmHg | P 97 BPM, regular | RR 16 breaths/min, unlabored | O2 99% RA

H 66in | W 155 lb. | BMI 25.0

Gen: Neatly groomed female. Looks her stated age of 29 years. Alert and cooperative and in no apparent distress.

CV: RRR. S1 and S2 are normal. No S3, S4, murmurs, splitting of heart sounds, friction rubs.

Pulm: Clear to auscultation and percussion bilaterally. Chest expansion symmetrical. No wheezing, rhonchi, rales, dullness.

A:

29 yo female with palpitations related to anxiousness and stress. Likely anxiety/panic disorder.

Differential Diagnosis:

1. Myocardial Infarction
2. Anxiety/Panic Disorder
3. Hyperthyroidism
4. Hypoglycemia
5. Pregnancy

P:

Labs:

• Beta-hCG with Reflex
• Troponin, R/O: MI
• CBC, BMP
• Finger stick Glucose
• TSH with Reflex
• U/A

Imaging/Tests:

• EKG

Likely Anxiety/Panic Disorder:

• Pending lab results to rule out medical etiologies, plan for discharge and to advise patient to follow up with PMD about symptomology. May then be referred to Psychologist, Psychiatry.

 

 

/s/ Daniel DeMarco, PA-S

Physician Assistant Student

 

Initial DDx Based on CC:                                              Adjusted DDx After H&P:

Anxiety/Panic Disorder                                               Myocardial Infarction

Atrial Fibrillation                                                         Anxiety/Panic Disorder

Atrial Flutter                                                               Hyperthyroidism

PSVT                                                                            Hypoglycemia

WPW Syndrome                                                          Pregnancy

Mitral Valve Prolapse

Myocardial Infarction

Medication Side Effect

Caffeine Consumption

Cocaine Use

Hyperthyroidism

Pheochromocytomatous

Hypoglycemia

Pregnancy