Skill Checkup: A 62-Year-Old Man With New-Onset Palpitations and Shortness of Breath During Hospitalization for Pneumonia

Sandeep K. Goyal, MD


April 03, 2023

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

A 62-year-old Black man presents to the emergency department with fever (102°F; 38.89°C), chills, malaise, and persistent, productive cough with rust-colored sputum that is tinged with green. He is using all his accessory muscles for respiration. The patient is a nonsmoker with long-standing hypertension with varied control that is currently managed with hydrochlorothiazide 50 mg per day, amlodipine 10 mg per day, and lisinopril 20 mg per day. Otherwise, his medical history is unremarkable. He is diagnosed with bacterial pneumonia and is admitted to the hospital. He is receiving ampicillin-sulbactam 3g IV every 6 hours and azithromycin 500 mg IV per day.

Three days after admission to the hospital, the patient's pneumonia-related symptoms are improving, but he is exhibiting a new set of symptoms: abrupt onset of episodic palpitations with shortness of breath. Physical exam reveals irregularly irregular beats on auscultation. Heart rate is 140 bpm during these episodes, which last for variable lengths of time.


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