Physician's Assistant

Refined clerking Mon 09 February 2026 19:09

Last Modified: 8 weeks ago

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Content:

Medical ST5 Miller Clerking
09/02/2026 19:00

Presenting Complaint:
Collapse and palpitations

History of Presenting Complaint:
On Saturday morning, whilst making tea for his wife, patient suddenly collapsed in the kitchen and fell backwards, hitting his head on the worktops. 
During the collapse, he experienced what he described as an "electrical short" sound through his head lasting approximately one second.

The following morning (Sunday) he woke with palpitations. He reports similar episodes previously, approximately two years ago, when his heart went into atrial fibrillation and he collapsed in the kitchen.

Patient has been suffering from a persistent cough for several weeks, described as a viral illness circulating before Christmas. The cough is severe enough that he needs to hold his chest whilst coughing. He has also been experiencing severe headaches since the collapse and feeling that something isn't right.

Past Medical History:
• Age-related macular degeneration
• Heart failure with reduced ejection fraction
• Atrial fibrillation with rapid ventricular response
• Non-alcoholic fatty liver disease
• Inflammatory arthritis (seronegative)
• Left knee osteoarthritis
• Central hypertension

Drug History:
• Edoxaban 60mg PO OD
• Ramipril 2.5mg PO OD
• Spironolactone 25mg PO OD
• Amlodipine 10mg PO OD
• Bisoprolol 1.25mg PO OD
• Ibuprofen gel topical PRN
• Amiodarone 100mg PO OD
• Sacubitril/Valsartan 49/51mg PO BD
• Fluticasone nasal spray 1-2 sprays OD
• Omeprazole 20mg PO BD
• Amitriptyline 10-20mg PO ON
• Methotrexate 15mg PO once weekly
• Folic acid 5mg PO OD
• Paracetamol 1g PO QDS PRN
• Atorvastatin 20mg PO OD

Investigations:
• FBC: Normal
• LFTs: Normal
• Coagulation screen: Normal
• Eosinophils: Normal
• CRP: 2
• Urea: Normal
• AST: Normal

Impression:
DDx: 
Arrhythmia-induced syncope
Intracranial bleed (post-anticoagulation and head trauma),

Management Plan:
Does not want to come back to hospital this evening - aware of the risks that he may be bleeding 
Therefore, advised to come to AMU tomorrow morning for CT Head, Bloods and review
Safety-netting advice given

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Summary:

Investigations:

Refined clerking Mon 09 February 2026 19:09

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