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 so the patient is carolyn thomas alpha111861 most recent episode when walking up hill in edinburgh where was not able to complete when other friends were able to full stop felt short of breath with concomitant palpitations and sensation of irregular but fast heart rate full stop no chest pain no leg claudication no cough or sputum production full stop retired primary school teacher and also mns bakery worker full stop no pets at no birds at home only dogs and cats does not live on a farm no exposure to hay or molds full stop on examination no leg swelling no rashes regular peripheral pulses at 80 beats per minute heart sounds soft ejection systolic murmur radiated into the carotids lungs clear to auscultation impression to exclude chronic pulmonary embolism if chronic pulmonary embolism excluded to explore paroxysmal arrhythmia or valvular heart abnormality that's a cause of symptoms plan number 1 ctpa number 2 repeat blood tests including troponin and electrolytes yes this lady's 65 she's had several months history of paroxysmal tachycardias which she reports as regular but her limiting her exercise tolerance with associated shortness of breath she's not able to keep up with her friends she's struggled to get up her recent at the hill in edinburgh I can't remember what it's called but she tried to walk up it but couldn't get to the top her d dime is raised I'm worried about chronic pe yeah nought 0.9 I mean she's well we could wait if you want but obviously it'd be nice to get it done yeah yeah I can do it in a week guess haven't thought about that but I've done doacs and then bring her back monday or whatever yeah yeah I mean can yeah yeah for sure I can I can treat her and bring her back I just wondered if you had a slot today and we could just get it done and she'd have a 1 and done in the day otherwise she's come here and then waited and then really for sure I guess the good thing is you know she can walk around so if you've got the scanner I can call the scanner and just put her in their waiting room and maybe if they get a chance between patients you know the port is delayed they just scan her quickly if it is scanner time that you are short of but if it is reporting time completely get that for you for sure whatever works for you really don't you oh god like why yeah what a nightmare yeah no I know that would be lovely she's a nice lady it would be nice to get her sorted I think so you're a legend yep I'll do that I really appreciate it thanks mate talk to you soon bye