Skill Checkup: A 58-Year-Old Woman With New-Onset Palpitations, Shortness of Breath, and Fatigue on Exertion

Lawrence Rosenthal, MD, PhD, FACC, FHRS


September 09, 2022

The Skill Checkup series provides a quick, case-style interactive quiz, highlighting key guideline- and evidence-based information to inform clinical practice.

A 58-year-old Hispanic woman presents with new-onset palpitations, shortness of breath, and fatigue on exertion. She reports that the symptoms are interfering with her daily activities. She has noticed that symptoms grow worse after drinking alcohol, which she does socially a few times a week. She reports minimal stressors and no difficulty sleeping. She has long-standing hypertension, which is well controlled with hydrochlorothiazide 50 mg, amlodipine 10 mg, and lisinopril 20 mg daily. She also has long-standing dyslipidemia, which is well controlled with atorvastatin 20 mg daily. She reports that she has taken an over-the-counter marine omega-3 fish oil supplement with eicosapentaenoic acid and docosahexaenoic acid, 4 g daily, for 10 years. She takes naproxen occasionally (one to two times per week) for mild arthritis pain. Family history reveals a history of breast cancer (sister and grandmother).

The patient is 5'3" (1.61 m) and weighs 161 lb (73.02 kg; body mass index [BMI] 28.5 kg/m2). She is a nonsmoker and drinks two to three cups of coffee daily. She walks 1.5-2 miles most days. Examination revealed no neurologic deficit or cerebellar signs. The chest had good bilateral air entry, and the abdomen was soft and lax. The patient was hemodynamically stable. The heart rate is 110 bpm.


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