CASE STUDY: Elevated Heart Rate and Heavy Breathing
A 45-year-old female patient presents to the office with complaints of her heart rate racing, breathing hard when doing usual physical activities, and feeling excessive fatigue for more than 1 month.
History of Present Illness, Review of Symptoms, and Health History
The patients initial vital signs are temperature 36.8C, heart rate 85, respiratory rate 20, blood pressure 140/68. The patient is at rest and has been for more than 10 minutes. The patient denies any history of cardiac conditions, hypertension, or abnormal lab findings. The history is positive for depression, hypothyroidism, seasonal allergies, and appendectomy. The patient takes Amour thyroid 30 mg once daily, daily fiber supplement, and multivitamin.
Physical Exam
GENERAL: Well-nourished, healthy appearing woman appropriate weight for height.
HEAD/NECK: No carotid bruits, no lymphadenopathy, no obvious JVD. Thyroid is palpable and smooth.
CV: Heart rate and rhythm regular, no murmur, S1 and S2 distinct. Peripheral pulses are equally palpable and bounding. No chest pain reported.
LUNGS: Breath sounds full, equal, and clear to auscultation. No retractions noted. Negative tactile fremitus, no egophony noted. O2 Sat 96%.
ABDOMEN: Soft, non-tender, non-distended. No hepatosplenomegaly, HJR negative.
NEURO/PSYCH: Speech is clear and distinct. Appearance, behavior, and cognition appropriate for the circumstances.
MUSCULOSKELETAL: Equal strength bilaterally, full ROM in all extremities.
1. Explain why it is significant that the clinician did not detect an S3 or S4 sound.
2. What is the significance of the patient currently taking Amour thyroid?
3. Should the clinician consider performing stress testing or other noninvasive advanced cardiac imaging procedures at this time? Explain.
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