Palpitations in a 19-Year-Old With a Rash

Jason S. Chang, MD; Carin M. Van Gelder, MD


May 14, 2015

Physical Examination and Workup

On physical examination, the patient appears to be in no acute distress, but he is noted to have moderate anxiety. He does not appear ill and is alert.

The patient's vital signs include a temperature of 96.7°F (35.9°C), a pulse rate of 40-120 beats/min, a respiratory rate of 16 breaths/min, and a blood pressure of 102/46 mm Hg. His oxygen saturation is 96% while breathing room air. His head and neck examination is unremarkable. No jugular venous distention or carotid bruits are noted. His lungs are clear to auscultation bilaterally.

The patient's cardiac examination reveals an irregular, tachycardic rhythm. No discernible murmur is observed with or without Valsalva maneuvers or hand clenching. His abdomen is soft, nontender, and nondistended. No clubbing, cyanosis, or edema is noted in his extremities. His neurologic examination findings are normal. On skin examination, multiple, bilateral macular erythematous lesions with large central pallor are noted on his thighs.

An ECG is obtained (Figure 2).


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