Medicine Discussion: PALPITATIONS IN 47 Y/O MALE

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CHIEF COMPLAINT : 47 y/o businessman with palpitations since last 5 days.

PRESENT HISTORY :

Pt was apparently asymptomatic 5 days ago after which he experienced sudden onset awareness of his heart beat accompanied by impending sense of doom, which was irregular and forceful in nature ; occurring intermittently over the course of past 5 days, (irrespective of rest/active) - lasting a duration of 5-10 minutes and regressing spontaneously ; perceived more during evening ;

Associated with difficulty in breathing even at rest / not strenuous activity

It is not associated with any triggers like strenuous exercise/ intake of anti-diabetic medication or fasting / consumption of tea and coffee / vomiting and diarrhoea

No h/o associated dizziness , headache, chest pain and fainting / tingling in hands and face / polyuria

He is not sure if it is associated with sweating, he describes himself as someone who is almost always perspiring.

He gives a h/o significant weight loss in the last 1 month

H/o anxiety wrt health and stress about family issues - sent for a psychiatry referral which indicated towards a probable panic attack

PAST HISTORY :

Pt was diagnosed with B/L CAP with ARDS 1 month ago, for which he was on ventilator for 20 days during which he had an acute MI.

He was given medication for one week following discharge which was discontinued immediately for reasons unknown

K/c/o HTN and DM since 10 years, on medication.

FAMILY HISTORY :

Mother is k/c/o HTN and DM

PERSONAL HISTORY :

Diet - Mixed
Appetite - Normal
Bowel & Bladder - Regular
Sleep - Markedly reduced after discharge from hospital, sleeps only with sleeping pills.
Addictions - None
Drug / Food Allergies - H/o anaphylaxis to Valproate ( DICORATE ER)

DRUG HISTORY :

Currently the patient is on

Antiplatelets
Statins
Anti-Arrhythmics
Benzodiazepine

Along with

Anti-HTNives
OHAs

CASE SUMMERY

47 y/o male k/c/o DM and HTN on medication since 10 years with h/o unprovoked intermittent Palpitations and Grade III - IV SOB which regress spontaneously within 5 to 10 minutes with significant wt loss in last 1 month and h/o ?panic attack as per psychiatry dept referral

GENERAL EXAMINATION :

Pt is Conscious, coherent and cooperative ; oriented to time, place and person ; moderately Built and Moderately Nourished

No pallor/icterus/cyanosis/clubbing/lymphadenopathy/edema