CASE DISCUSSION A 67-year-old man presents after experiencing palpitations while having dinner with his wife. He describes his heart as "flopping around" in his chest. This sensation lasted for a few minutes and was suddenly followed by lightheadedness and a transient loss of consciousness. His wife reports that he woke up almost right away, within a few seconds. He felt normal afterward. He denies any prodrome and any symptoms of vertigo. During his interview, he discloses a similar episode about 1 month prior, albeit of milder intensity. That episode was not associated with a loss of consciousness. His past medical history includes hypertension, which is controlled with a diuretic and an angiotensin receptor blocker, and Gilbert disease without significant liver dysfunction. He takes a baby aspirin daily. He is active, exercises regularly, and works a full-time job. He has not had any symptoms such as chest pain, shortness of breath, or palpitations, presyncope, or syncope associated with exercise. He does not smoke or consume alcohol. He has no known food or drug allergies. His family history includes hypertension on his maternal side without any history of syncope or unexplained sudden death. PHYSICAL EXAMINATION AND WORK UP Physical examination in the office revealed a healthy-appearing man in no distress. His vital signs were normal. His physical examination findings were also normal, including a thorough cardiovascular evaluation that revealed no abnormal heart sounds including murmurs, rubs, or gallops. He had normal carotid pulses, as well as in his upper and lower extremities. An ECG revealed normal sinus rhythm with normal conduction intervals, with no evidence of ischemia and no signs of a prior myocardial infarction. An echocardiogram showed mild left ventricular hypertrophy and normal biventricular function, normal valve function, mild atrial enlargement, and Doppler evidence of impaired ventricular relaxation. Complete blood count and comprehensive chemistry panel findings were normal, except for mildly elevated bilirubin. His thyroid-stimulating-hormone level was normal. What is your diagnosis amd approach?
Needs a more advance cardiac work up like a holter monitor and a cardiac MRI. Neuro work up to rule out seizures. Need labs to check out blood and WHY IS PT ON ASPIRIN DAILY? Any jaundice?
Somatic symptoms disorder, gently approach then consult to psychiatrist.
