MDM - Benign Palpitations

[##-year-old male/female] with history and exam consistent with likely benign palpitations.

Initial considerations in this patient included benign etiologies of palpitations including premature ventricular contractions (PVCs), premature atrial contractions (PACs) and premature junctional contractions (PJCs), more significant dysrhythmias including long QT syndrome, Wolff-Parkinson-White syndrome, and Brugada syndrome among others, atrioventricular blocks, acute coronary syndromes, anxiety disorders, thyroid disorders, and palpitations secondary to drugs and medications among others.


Patient presented with report of [## hours/days] of palpitations described as [irregular/rapid and irregular heartbeat/"skipping" heartbeats].  A 12-lead EKG was obtained [with evidence of occasional/frequent PACs/PJCs/PVCs/no evidence of significant dysrhythmia, ectopy or accessory pathways and no evidence of acute ischemia or infarction as noted above].  Labs were obtained in the evaluation of this patient to include [a basic/complete metabolic panel and thyroid studies], which were [noted to be unremarkable/notable for describe abnormality].  Patient [with/without] significant [caffeine/supplement] use [with discussion of decreased use or cessation]. Patient [reported/denied] associated chest pain, and was noted to have no significant risk factors for acute coronary syndrome.

Prior to discharge, we discussed return precautions, specifically for chest pain or other symptoms suggestive of significant cardiac illness, and follow up with primary care doctor for further evaluation and consideration of referral to Cardiology, and the patient demonstrated understanding and agreement with this plan. [A consult was placed for a Holter/event monitor prior to discharge from the ED.]