Fatigue and Palpitations in a 53-year-old Woman

History of Present Illness

A 53-yr-old woman comes to the office because of palpitations. She is a current patient there and has a history of well-controlled hypertension, type 2 diabetes, and tension headaches. She states that she has noticed intermittent palpitations over the past 2 mo. She describes the episodes as a sensation of irregular and racing heartbeats that are accompanied by fatigue. She denies any chest pain, shortness of breath, light-headedness, or syncope. The episodes last from 10 min to several hours, occur once or twice/wk, and resolve on their own. The last episode was 3 days ago. She cannot identify any particular triggers. She is generally active and walks 3 miles several days/wk without any exertional symptoms including chest pain and dyspnea. She has no family history of early cardiac disease or sudden death. She denies any recent fever or infectious symptoms.

Patient 010