Instructions
You are a medical student on placement in general practice. Sonia Petrakis, 42, is here for the results of her heart tests for palpitations. They are below.
Take a focused history
Interpret the results
Explain the results and your management plan to the patient
24-hour Holter monitor report
| Item | Value | Reference range |
|---|---|---|
| Underlying rhythm | Sinus rhythm throughout; heart rate 52-138 /min (mean 76) | Sinus rhythm |
| Ventricular ectopic beats | 2,900 in 24 hours (3.2 percent of beats); single morphology; no couplets; no runs beyond 3 beats | Burden under 10 percent generally benign in a normal heart |
| Supraventricular ectopic beats | 180 in 24 hours; no runs | Occasional |
| Pauses and conduction | No pauses over 2 seconds; PR and QRS normal throughout | No pauses over 3 seconds |
| Symptom diary correlation | All 11 diary entries ('thump', 'skipped beat') correspond to isolated ventricular ectopics; most entries between 8 pm and midnight | n/a |
Reported by the cardiology service; no further action recommended in the absence of structural heart disease.
Echocardiogram, resting ECG and bloods
| Item | Value | Reference range |
|---|---|---|
| Echocardiogram | Normal left ventricular size and systolic function, ejection fraction 62 percent; normal valves; no regional wall motion abnormality; normal right heart | Ejection fraction over 55 percent |
| Resting 12-lead ECG | Sinus rhythm 72; PR 150 ms; QRS 84 ms; QTc 420 ms; no pre-excitation; one ventricular ectopic captured | Normal |
| TSH | 1.4 mIU/L | 0.4-4.0 mIU/L |
| Haemoglobin | 132 g/L | 115-160 g/L |
| Potassium and magnesium | 4.2 mmol/L; 0.85 mmol/L | 3.5-5.2; 0.7-1.1 mmol/L |
All arranged by the GP after the first consultation three weeks ago.