Physician's Assistant

Sdec Sat 28 June 2025 09:26

Last Modified: 282 days ago

MRN:

Content:

Presenting Complaint:
Elevated heart rate on exertion

Past Medical History
• Episodes of unexplained tachycardia at rest in 2021 (2-3 years ago)
• Two episodes occurring months apart whilst at rest with no identifiable trigger

Diagnosis:
Exercise intolerance with exertional tachycardia

I had the pleasure of meeting Carolyn Thomas in Same Day Emergency Care today.

Ms Thomas presented with a history of elevated heart rate on exertion, reporting that her heart rate increases to 150-160 bpm even with minimal activity such as walking up a slight hill. She acknowledges that heart rates normally increase with exercise but feels her response is excessive. She also reports a previous history of unexplained episodes of tachycardia at rest approximately 2-3 years ago (around 2021), where her heart rate would suddenly increase whilst sitting at home with no obvious trigger. These episodes occurred twice within a couple of months of each other but have not recurred since.

Investigations:
• TSH: 3.6
• CRP: 2
• NT-proBNP: 24
• LFTs: Normal
• U&Es: Normal
• FBC: Normal
• D-dimer: 0.9 (high)
• ECG: Sinus rhythm, 86 bpm, no electrocardiographic evidence of pulmonary embolism

Plan:
1. Further cardiac evaluation to investigate exercise intolerance and exertional tachycardia
2. Consider exercise stress testing to assess cardiac response to exertion
3. Follow-up regarding elevated D-dimer result

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Summary:

Investigations:

Sdec Sat 28 June 2025 09:26

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