A 35-Year-Old Man With Palpitations and Dizziness

Christopher Redmond, MD, MSc; Kristine M. Lohr, MD, MS

Disclosures

August 31, 2016

Physical Examination and Workup

The patient appears fatigued but well-developed and well-nourished. Vital signs are all within the reference range. No significant change in blood pressure is noted when he goes from the supine to seated or seated to standing positions. His skin is warm and dry without rash. His head is atraumatic. He has no conjunctival injection or exudate. Pupils are equal, round, and reactive to light. No deficit in extraocular movement is observed.

Figure 1.

Oral examination reveals no lesions, retropharyngeal erythema, or exudate. No cervical or axillary lymphadenopathy is identified. Cardiac examination is significant for bradycardia (50 beats/min at a regular rate with no murmur, rubs, or gallops). His point of maximum impulse is within the midclavicular line. Radial and posterior tibialis pulses are regular and equal bilaterally. He has no increased work of breathing or accessory muscle use with respiration. Lung fields are clear to auscultation bilaterally with no crackles or wheezing.

No swelling of his knees or any other joints is observed. He has unrestricted passive and active range of motion in all four extremities. Assessment of his strength and sensation in upper and lower extremities reveals no deficits. Cranial nerve examination findings are normal bilaterally. He has no appreciable photophobia, neck stiffness, or neck pain with flexion of his legs. Genitourinary examination findings are negative for scrotal edema/tenderness, genital lesion, and penile discharge.

Electrocardiography reveals normal sinus rhythm, with a prolonged PR interval of 280 msec. The PR interval is the same length throughout. The QRS interval is narrow with no significant changes in amplitude. No acute ST- or T-wave abnormalities are noted (Figure 1).

Blood work is unremarkable. No leukocytosis, anemia, or thrombocytopenia is observed. Sodium, potassium, calcium, and magnesium levels are all within the reference range. Creatinine and estimated glomerular filtration rate reveals normal kidney function.

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