Tachycardia in a 61-Year-Old Woman

Jeffrey Siegelman, MD; Daniel M. Lindberg, MD

Disclosures

June 24, 2015

Physical Examination and Workup

Upon examination, the patient is awake and fully oriented. She is diaphoretic but in no apparent distress. Her temperature is 97°F; her pulse is 160 beats/min; her respiratory rate is 24 breaths/min, with an oxygen saturation of 98%; and her blood pressure is 190/117 mm Hg.

The patient has bilateral exophthalmos with exotropia of the right eye. Her visual acuity is normal, and her extraocular movements are intact.

The neck examination reveals a diffuse, nontender goiter, without nodules or thyroid bruits. The heart is tachycardic, intermittently irregular, and without murmurs. The lungs are clear to auscultation bilaterally. The abdomen is nondistended, soft, and nontender, with no palpable masses. No edema is observed in the extremities.

The neurologic examination reveals normal mentation, intact cranial nerves, intact motor strength and sensation, and normal reflexes. No tremor is noted.

The initial laboratory studies reveal that the patient's complete blood cell count, electrolytes, renal function, and cardiac marker findings are all within normal limits. Plain chest radiography findings are normal. An ECG is obtained (Figure).

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