Transcription - 20250628T 10-04.mp3

So it's an steg review for carolyn thomas that's c a r a o l y n thomas out 6 1 investigations tsh 3.6 crp 2 nt pre bnp 24 lft is normal use any normal full blood count normal d dimer 0.9 open brackets high close brackets ecg sinus rhythm 86 beats per minute no electrophysiological evidence of or electrocardiographic evidence of pulmonary embolism tell me all about it okay so it's a bit of a long story I just seem to get an elevated heart rate when I do any kind of exercise and I realize everybody's hearts go up but mine goes up to like a 150 160 but that's even just walking say for a slight hill I've been in a couple of times before maybe 2 or 3 years ago it's for no reason whatsoever just sitting at home doing nothing my heart rate would just suddenly go up high and like no explanation of doing anything so that happened twice quite quickly together maybe a couple of months apart not done it for a long time years ago it was maybe 2 or 3 years ago maybe 2021 I think it was at the time nothing was unusual and

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

Summary

Investigations

Plans