Tachycardia in a 61-Year-Old Woman

Jeffrey Siegelman, MD; Daniel M. Lindberg, MD


June 24, 2015

Editor's Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case you would like to suggest for a future Case Challenge, please contact us.


A 61-year-old woman presents to the emergency department after being referred from her primary care provider's office for evaluation of tachycardia. She had been seen by her primary care provider for a routine purified protein derivative tuberculin skin test and was incidentally noted to have a pulse of 160 beats/min.

The patient denies any specific symptoms other than occasional palpitations. Upon review of her systems, however, she notes having night sweats; a 110-lb weight loss over the preceding 12 months; and 2-3 months of anxiety, diarrhea, and occasional diplopia. She denies having any fever, chills, chest pain, dyspnea, or swelling in her extremities.

The patient has a medical history of an unspecified thyroid problem. She does not take any daily medications and has no medication allergies. She has a 50–pack-year smoking history, with occasional alcohol consumption. She had been homeless for a time, but is currently living in an apartment.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.