MEDizzy - A 47-year-old woman with a history of tobacco abuse and

Feed Library Learning Discuss Leaderboard Journal

Disorders of the Cardiovascular System

A 47-year-old woman with a history of tobacco abuse and ulcerative colitis is evaluated for intermittent palpitations. She reports that for the last 6 months every 2–4 days she notes a sensation of her heart “flip-flopping” in her chest for approximately 5 minutes. She has not noted any precipitating factors and has not felt lightheaded or had chest pains with these episodes. Her physical examination is normal. A resting ECG reveals sinus rhythm and no abnormalities. Aside from checking serum electrolytes, which of the following is the most appropriate testing?

ExplanationThe patient has persistent, non–life-threatening palpitations that distress her enough to seek medical attention. A continuous Holter monitor for 24 hours is appropriate for patients in whom the symptoms happen several times a day in which an event monitor is triggered by the patient when symptoms occur and thus can be worn for a longer period of time. There is no indication of gastrointestinal triggers, so abdominal CT would not be helpful. The atrial premature contractions are uncomplicated, do not require additional diagnostic evaluation at this time, and pose no additional health risk. EP referral is indicated for patients with life-threatening or severe symptoms such as syncope.