27 year old female presenting with palpitations

Amrit Misra on May 26, 2013

27 year old female presents to your clinic complaining of episodic palpitations and headaches.  With regard to the palpitations, she reports that they started about three months ago, and have been increasing in frequency, occuring three to four times a week currently.  She reports the episodes last around 30 minutes to an hour at the time and are associated with shortness-of-breath, nausea, and an impending sense of doom.  With regading the headaches, she notes that they also have occuring over the past three months and over the psat month have been occuring daily.  She reports the pain is mainly in the front of her head, and is non-radiating.  She denies any visual changes, neurological deficits, or photophobia associated with the headaches.

PMHx, PSHx, FMHx: Unremarkable

Medications/Allergies: None

Social: Non-smoker, drinks occasionally.  No illicit drug use.

  • Temp  37 C
  • HR  120
  • BP  180/90
  • RR  16
  • O2  95% on Room Air

Physical Exam:

General: Well appearing woman, sitting on examination table, in no acute distress.

Cardiovascaulr: Tachycardic, with regular rate. No s1 or s2 audible.  No murmurs, rubs, or gallops.

Lungs: Clear bilaterally to auscultation. No wheezes, rales, or crackles

Abdominal: Soft, non-distended, non-tender.  No rebound tenderness or guarding.

MSK: No cyanosis, clubbing or edema.  No rashes visisble on exposed skin.

What is on your differential?

Select all that apply
Expand all answers
Hyperthyroidism
Yes, this is on your differential. Hyperthyroidism can account for the palpitations, but would not account for the headaches.


Panic attack
Yes, this is on your differential. However, this should be considered a diagnosis of exclusion as it is important to rule out more insidious causes of her palpitations and headaches.


Myocardial infarction
No, this seems less likely given her age, lack of risk factors, and the episodic nature of these spells.


Pheochromocytoma
Yes, this is on the differential given her headaches, palpitations, and hypertension.


Pulmonary embolism
No, this is less likely given the episodic nature of these spells.


Carcinoid tumor
Yes, this is on the differential as well.


Cushing's syndrome
Yes, this is on the differential as well, though she does not seem to have cushingoid signs on physical exam


27 year old female presents to your clinic complaining of episodic palpitations and headaches.  With regard to the palpitations, she reports that they started about three months ago, and have been increasing in frequency, occuring three to four times a week currently.  She reports the episodes last around 30 minutes to an hour at the time and are associated with shortness-of-breath, nausea, and an impending sense of doom.  With regading the headaches, she notes that they also have occuring over the past three months and over the psat month have been occuring daily.  She reports the pain is mainly in the front of her head, and is non-radiating.  She denies any visual changes, neurological deficits, or photophobia associated with the headaches.

PMHx, PSHx, FMHx: Unremarkable

Medications/Allergies: None

Social: Non-smoker, drinks occasionally.  No illicit drug use.

  • Temp  37 C
  • HR  120
  • BP  180/90
  • RR  16
  • O2  95% on Room Air

Physical Exam:

General: Well appearing woman, sitting on examination table, in no acute distress.

Cardiovascaulr: Tachycardic, with regular rate. No s1 or s2 audible.  No murmurs, rubs, or gallops.

Lungs: Clear bilaterally to auscultation. No wheezes, rales, or crackles

Abdominal: Soft, non-distended, non-tender.  No rebound tenderness or guarding.

MSK: No cyanosis, clubbing or edema.  No rashes visisble on exposed skin.

What is on your differential?

Select all that apply
Expand all answers
Hyperthyroidism
Yes, this is on your differential. Hyperthyroidism can account for the palpitations, but would not account for the headaches.


Panic attack
Yes, this is on your differential. However, this should be considered a diagnosis of exclusion as it is important to rule out more insidious causes of her palpitations and headaches.


Myocardial infarction
No, this seems less likely given her age, lack of risk factors, and the episodic nature of these spells.


Pheochromocytoma
Yes, this is on the differential given her headaches, palpitations, and hypertension.


Pulmonary embolism
No, this is less likely given the episodic nature of these spells.


Carcinoid tumor
Yes, this is on the differential as well.


Cushing's syndrome
Yes, this is on the differential as well, though she does not seem to have cushingoid signs on physical exam


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