Osce - Palpitations, AF, ECG 4 year old lady presents with palpitations History ‘of presenting complaint : ¥ How long for (3 episodes in last week) Onsctlofisct — (sudkden onset and affsct, out of the blue) Duration (a few minutes) Pattern (irregular, tap it out) Past history of palpitations (no) RN885 Stressiworry/excitement? (not particularly) Chest pain or breathlessness? (ischaemic cause or secondary to AS, anxiety with hyperventilation, MS or CCF) (some SOB when the attacks come on) (important to know if symptomatic) Dizziness or faintness ~ suggests severe arrhythmias such as sick sinus, complete heart block (no) 2. Medication (aminophylline, salbutamol, antidepressants TCAs and MAOIs, digitalis, class 1A & 1C antiarthythmics, diuretics (1K & Mg), GTN, nasal decongestants, thyroxine) none) 3. Caffeine, alcohol; nicotine, cocaine, marijuana (1 cup tea, 2 drinks alcohol) 4. Phx of theumatic fever / known heart murmur’ (no) 3. Sx of thyrotoxicosis (LOW, sweating, diarrhoea ec.) (no) ECG ne 1 2. Cardiac enzymes, 2. Echocardiogram looking for (1) valvular HD (2) left ventricular function (3) ‘mural thrombus. TFTs . URES Mg FBE & blood film . CXR Noga Phys examination: nature of pulse, rate (100-150 suggests sinus tachy, >150 suggests AF, Aff, SVT or VT. Fever, infection, depression, anxiety, underlying anaemia, thyroid, alcohol abuse, cardiac disease including mitral valve prolapse. Please i following ECG. 1. AF 2. Digoxin 3, No ischaemia