Fatigue and Palpitations in a 53-year-old Woman

Past Medical History

  • Medical history: Hypertension, type 2 diabetes, and tension headaches.

  • Surgical history: Appendectomy at age 20.

  • Medications: Lisinopril 10 mg daily and metformin 500 mg bid.

  • Allergies: No known drug allergies.

  • Family history: Mother is alive and has hypertension and diabetes mellitus. Father died of lung cancer. No history of early coronary artery disease or sudden cardiac death.

  • Social history: Patient is married and works as a school teacher. Regularly exercises 3 times/wk. No history of smoking. Drinks a glass of wine with dinner most nights and one cup of coffee each morning. Denies use of decongestants, cocaine, and other stimulants. No illicit drug use.