Paroxysmal supraventricular tachycardia Unspecified essential hypertension Other and unspecified hyperlipidemia
 
Name:  ___                    Unit No:   ___
 
Admission Date:  ___              Discharge Date:   ___
 
Date of Birth:  ___             Sex:   F
 
Service: MEDICINE
 
Allergies: 
NSAIDS (Non-Steroidal Anti-Inflammatory Drug) / ibuprofen / 
Novocain / lovastatin
 
Attending: ___
 
Chief Complaint:
Palpitations
 
Major Surgical or Invasive Procedure:
None

 
History of Present Illness:
___ PMH of AVNRT, HTN who presents w/ palpitations, SOB which 
had resolved prior to arrival to ED, and was admitted to ___ 
for workup.  
Pt noted that she has episodes of palpitations frequently, 
sometimes as much as 1x wk, and had a holter in ___ which 
did not show any e/o AVNRT. Diltiazem then switched to 
metoprolol/verapamil in ___ and pt felt that symptoms were 
greatly improved. However, over the last few weeks have had much 
longer lasting episodes, sometimes up to hours in duration. Pt 
called outpt cardiologist last ___ who rec'd 40mg verapamil to be 
taken prn in addition to TID dosing. Pt followed such 
intructions to good effect.  
Yesterday, pt had episode that lasted 4 hours from 4:30pm to 
8:30pm, despite taking 40mg verapamil at 5:30pm. It then 
recurred at 9:30pm so pt took another 40mg verapamil and called 
EMS. She denied any preceeding ACS symptoms, but endorsed SOB 
during episode of palpitations. Pt routinely checks her pulse 
during such episodes, and noted that HR feels fast/regular, w/ 
occasional pauses.  
On ROS, pt denied any infectious symptoms (cough, fever, 
chills), or heart failure symptoms (orthopnea, wt gain). 
 
In the ED, initial VS were: 68 123/68 20 94% RA. Pt was not 
tachycardic in ED. Labs were significant for normal 
WBC/CHEM/UA/Trop. Pt was not given any medication and was 
admitted to ___ for further evaluation. Overnight, pt reports 
doing well. She still has occasional palpitations. Otherwise, no 
CP, light-headedness or SOB.

 
Past Medical History:
1. Episodic cardiac arrhythmia
2. Hypertension
3. Hypercholesterolemia
4. Elevated calcium level (measured at 10.2 1 month ago)
5. Irritable bowel syndrome (periodic diarrhea)
6. Back pain
7. s/p ORIF L bimalleolar ankle francture (___)
8. osteoporosis

 
Social History:
___
Family History:
Patient's Father: coronary artery disease (died at age ___
Patient's Mother: heart valve dysfunction (specifics unknown)
Patient's Daughter: parathyroid gland removed

 
Physical Exam:
On Admission:
Vitals - T97.5, BP 159/75 P58, R20, O297RA  
GENERAL: NAD, sitting in bed, pleasant  
HEENT: MMM, supple neck  
CV: RRR no m/r/g, normal S1/S2  
LUNGS: CTA b/l, no wheezes/rales/rhonchi  
ABD: Soft, NT, ND, normoactive BS  
EXT: Warm, well perfused, no edema  
NEURO: fluent speech, AOx3, no focal deficits 

At Discharge:
VS: 97.5/97.5; 151-159/55-75; 53-58; 20; 95-97% RA  
GENERAL: WDWN F in NAD. Oriented x3. Mood, affect appropriate.  
HEENT: NCAT. Sclera anicteric. PERRL, EOMI. Conjunctiva were 
pink, no pallor or cyanosis of the oral mucosa. No xanthelasma.  

NECK: Supple with no JVD.  
CARDIAC: PMI located in ___ intercostal space, midclavicular 
line. RR, normal S1, S2. No m/r/g. No thrills, lifts. No S3 or 
S4.  
LUNGS: No chest wall deformities, scoliosis or kyphosis. Resp 
were unlabored, no accessory muscle use. CTAB, no crackles, 
wheezes or rhonchi.  
ABDOMEN: Soft, NTND. No HSM or tenderness. Abd aorta not 
enlarged by palpation. No abdominal bruits.  
EXTREMITIES: Trace pitting edema in ___, R>L. No cyanosis or 
clubbing. No femoral bruits.  
SKIN: No stasis dermatitis, ulcers, scars, or xanthomas.  
PULSES:  
Right: Radial 2+ DP 2+ ___ 2+  
Left: Radial 2+ DP 2+ ___ 2+  

 
Pertinent Results:
On Admission:
___ 11:36PM BLOOD WBC-7.5 RBC-4.31 Hgb-14.0 Hct-39.3 MCV-91 
MCH-32.5* MCHC-35.7* RDW-14.4 Plt ___
___ 11:36PM BLOOD Neuts-57.3 ___ Monos-6.7 Eos-1.8 
Baso-0.4
___ 11:36PM BLOOD Plt ___
___ 11:36PM BLOOD Glucose-122* UreaN-15 Creat-0.8 Na-140 
K-4.3 Cl-101 HCO3-25 AnGap-18
___ 11:36PM BLOOD cTropnT-<0.01

On Discharge:
___ 10:34AM BLOOD WBC-4.8 RBC-3.99* Hgb-12.6 Hct-36.8 
MCV-92 MCH-31.5 MCHC-34.2 RDW-13.9 Plt ___
___ 10:34AM BLOOD Glucose-114* UreaN-13 Creat-0.8 Na-141 
K-3.8 Cl-100 HCO3-32 AnGap-13
___ 10:34AM BLOOD cTropnT-<0.01
___ 10:34AM BLOOD Calcium-9.6 Phos-3.2 Mg-2.1

STUDIES:
___ CXR:
IMPRESSION:    
No acute cardiopulmonary process. 

 
Brief Hospital Course:
___ PMH of AVNRT, HTN who presents w/ palpitations, SOB which 
had resolved prior to arrival to ED. Pt was monitored on 
telemetry overnight and had two short runs of narrow complex 
tachycardia. She was discharged with a plan to follow up with 
her primary cardiologist and consider possible EP study and 
ablation of AVNRT. No medication changes were made.

Transitional Issues:
-Follow up with primary cardiologist
-Consider electrophysiology evaluation to consider possible EP 
study and ablation
 
Medications on Admission:
The Preadmission Medication list is accurate and complete.
1. Lorazepam 0.5 mg PO DAILY:PRN anxiety 
2. Metoprolol Succinate XL 75 mg PO DAILY 
3. Verapamil 40 mg PO Q8H 
4. Aspirin 81 mg PO DAILY 
5. Pravastatin 20 mg PO QPM 

 
Discharge Medications:
1. Aspirin 81 mg PO DAILY 
2. Lorazepam 0.5 mg PO DAILY:PRN anxiety 
3. Metoprolol Succinate XL 75 mg PO DAILY 
4. Pravastatin 20 mg PO QPM 
5. Verapamil 40 mg PO Q8H 

 
Discharge Disposition:
Home
 
Discharge Diagnosis:
Primary:
Narrow complex tachycardia

Secondary:
Hypertension
Hyperlipidemia

 
Discharge Condition:
Mental Status: Clear and coherent.
Level of Consciousness: Alert and interactive.
Activity Status: Ambulatory - Independent.

 
Discharge Instructions:
Dear ___ were admitted to ___ 
because of palpitations. ___ were observed overnight, and we did 
not see anything concerning while monitoring your heart. ___ 
should continue taking your home medications as prescribed. ___ 
should also follow up with your primary cardiologist and ___ 
should talk with her about the possibility of getting a study to 
look more closely at your heart rhythm and to possibly "ablate" 
.

It was a pleasure to help care for ___ during this 
hospitalization, and we wish ___ all the best in the future.

Sincerely,
Your ___ Team
 
Followup Instructions:
___

{'Palpitations': ['Paroxysmal supraventricular tachycardia'], 'Shortness of breath': ['Paroxysmal supraventricular tachycardia'], 'Hypertension': ['Unspecified essential hypertension'], 'Hyperlipidemia': ['Other and unspecified hyperlipidemia']}