9/4/2023 0 Comments Heart quivering at night![]() ![]() ![]() Abdominal exam is benign, and patient has no peripheral edema. Heart exam is significant for mild displacement of point of maximum impulse laterally, no right ventricular lift, auscultation reveals regular and crisp S1, normally split S2, no S3, no S4, and no rub. No acute distress, no skin changes or rashes, no elevation in jugular venous pressure, and no carotid bruits. Physical examination: Pulse 72 beats per minute – regular and equal in both arms, blood pressure in left arm 130/85 mm Hg and 135/85 in the right arm. Patient denies any consumption of alcohol, illicit drugs, or supplements. ![]() Patient does not have significant family history of heart disease, diabetes, cancer, or congenital abnormalities, and he is compliant with yearly preventive visits to his primary physician. His medical history is significant for obesity (BMI = 34), treated hypertension (on hydrochlorothiazide 25 mg orally once daily), treated obstructive sleep apnea (he was seen at a sleep medicine center nine years ago, and he has been using a continuous positive airway pressure device every night since then), and history of tobacco use (15 pack/year history he completely quit smoking 12 years ago). The patient denies any episodes of syncope, pre-syncope, chest pain, shortness of breath, or significant changes in exercise tolerance, temperature tolerance, or any recent changes in medications. On further questioning he notes similar episodes of palpitations occurred earlier this year, approximately three times: all of them resolved spontaneously after one to three hours, and he did not seek medical attention for them. A 47-year-old Caucasian man presents to an outpatient appointment with abrupt onset of mild palpitations that occurred the same morning when he woke up, and lasted for 50 minutes during which the patient felt mild malaise. ![]()
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