Physician's Assistant

Patient Details

Sdec (282 days ago 09:26)

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:

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Sdec (282 days ago 09:35)

Sdec Sat 28 June 2025 09:35

Last Modified: 282 days ago

MRN:

Content:

Presenting Complaint:
Paroxysmal tachycardia with exercise intolerance and shortness of breath

Past Medical History:
• Episode of unexplained tachycardia approximately 2-3 years ago (2021)
• Two similar episodes occurring months apart, then resolved

Diagnosis:
Paroxysmal tachycardia - chronic pulmonary embolism to be excluded

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

This 65-year-old retired primary school teacher and bakery worker presented with several months history of paroxysmal tachycardia limiting her exercise tolerance. She reports her heart rate reaching 150-160 bpm with minimal exertion such as walking uphill. Most recently, whilst walking uphill in Edinburgh, she was unable to complete the walk when her friends were able to, experiencing shortness of breath with concomitant palpitations and sensation of irregular but fast heart rate. She denies chest pain, leg claudication, cough or sputum production. She had similar episodes 2-3 years ago (around 2021) where her heart rate would suddenly increase whilst at rest with no obvious trigger. These occurred twice within a couple of months then resolved.

She has no pets, birds at home (only dogs and cats), does not live on a farm, and has no exposure to hay or moulds.

O/E: No leg swelling, no rashes. Regular peripheral pulses at 80 bpm. Heart sounds with soft ejection systolic murmur radiating into the carotids. Lungs clear to auscultation.

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. CTPA to exclude chronic pulmonary embolism
2. Repeat blood tests including troponin and electrolytes
3. If chronic pulmonary embolism excluded, explore paroxysmal arrhythmia or valvular heart abnormality as cause of symptoms

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Summary:

Investigations: