New Onset Palpitations in a 67-Year-Old Female with Chronic Conditions

QUESTION

Chief complaint: “I feel like my heart is racing over the last two weeks off and on. Just feeling more tired than usual. I took a walk around the block with my husband the other night and just felt a little dizzy but then it went away.” History of Present Illness (HPI): Marie Michaelson is a 67 year old female. She was most recently seen in the office for adjustments in her diabetes therapy. She presents today with new onset of palpitations over the last two weeks. She reports she is aware of the palpitations but has become relatively symptomatic with fatigue and dizziness when physically active. PMH: Hypertension Type II DM Depression GERD PSH: Hysterectomy Bilateral cataract removal Family History: non-contributory Social History: non-smoker, non-drinker Allergies: Codeine Medication List: Metformin 1000mg bid Omeprazole 20 mg daily Metoprolol 50 mg bid Lisinopril 10 mg daily Sertraline 100 mg daily Review of Systems (ROS) Constitutional: energy level unchanged, appetite good HEENT: unremarkable Skin: dry skin Heart: Denies chest pain Lungs: Denies SOB, no orthopnea GI: Denies heartburn Neuro: denies headache, no syncope Recent labs: Sodium 140, Potassium 3.6, chloride 102, CO2 34.0, BUN 14, SCr 1.3, Calcium 8.8, A1C 7.1%, LDL

ANSWER

New Onset Palpitations in a 67-Year-Old Female with Chronic Conditions

Introduction

Marie Michaelson, a 67-year-old female with a medical history significant for hypertension, Type II diabetes mellitus, depression, and GERD, presents with a recent onset of palpitations over the last two weeks. She has experienced fatigue and dizziness during physical activity, prompting concern about her cardiac health. This case study delves into her medical history, medications, and recent lab results to provide insights into her condition.

Patient History

Marie’s recent health concerns center around palpitations, which she describes as intermittent but alarming. She is aware of her heart racing, and her symptoms have progressed to the point where she now experiences fatigue and dizziness during physical activities. Notably, she experienced a bout of dizziness during a recent walk with her husband. Marie’s past medical history includes hypertension, Type II diabetes, depression, and GERD, which collectively paint a picture of an individual with multiple chronic conditions.

Medication List

Metformin 1000mg twice daily – This medication is commonly used to manage blood sugar levels in individuals with Type II diabetes.
Omeprazole 20 mg daily – Omeprazole is a proton pump inhibitor prescribed to manage GERD symptoms by reducing stomach acid production.
Metoprolol 50 mg twice daily – Metoprolol is a beta-blocker often used to control blood pressure and heart rate.
Lisinopril 10 mg daily – Lisinopril is an ACE inhibitor used for hypertension management.
Sertraline 100 mg daily – Sertraline is an antidepressant frequently prescribed for depression.

Review of Systems (ROS)

Marie reports a stable energy level and good appetite. She denies chest pain, shortness of breath, or orthopnea. Her heartburn symptoms appear to be well-controlled with omeprazole. Marie denies headaches and syncope, providing essential information for evaluating her symptoms.

Recent Labs:
Sodium: 140 mEq/L
Potassium: 3.6 mEq/L
Chloride: 102 mEq/L
CO2: 34.0 mEq/L
BUN: 14 mg/dL
Serum Creatinine: 1.3 mg/dL
Calcium: 8.8 mg/dL
A1C: 7.1%
LDL: (value not provided)

Discussion

Marie’s presentation is concerning due to the new-onset palpitations and associated symptoms of fatigue and dizziness, which could be suggestive of an underlying cardiac issue. Her past medical history includes hypertension and diabetes, both of which are risk factors for cardiovascular problems. The medications she is currently taking, such as Metoprolol and Lisinopril, are commonly prescribed for blood pressure management.

It’s important to evaluate whether her palpitations are related to a medication side effect, cardiac arrhythmias, or other underlying issues. The recent lab results show a slightly elevated A1C (7.1%), indicating the need for ongoing diabetes management. However, the LDL value is not provided, making it challenging to assess her cardiovascular risk fully.

Conclusion

Marie Michaelson, a 67-year-old female with a history of hypertension, diabetes, and other chronic conditions, presents with new-onset palpitations, fatigue, and dizziness. Her medication list, including Metoprolol, raises questions about potential drug-related side effects. Further assessment, including a complete cardiac workup and the missing LDL value, is necessary to determine the underlying cause of her symptoms and to ensure appropriate management. Her overall health requires careful consideration, given her complex medical history.