CHIEF COMPLAINT: Rapid heart rate.
HISTORY OF PRESENT ILLNESS: This is a (XX)-year-old male who presented to the emergency department. Apparently, just prior to arrival, he left work, he was in his car when his heart started racing. He states that he did have some chest tightness, 4/10 in intensity. No shortness of breath, nausea or vomiting. The patient states that he had an ablation done previously. He states that he forgot to take his digoxin over the weekend. He has never had a stress test.
PAST MEDICAL HISTORY:
1. SVT.
2. Hypertension.
MEDICATIONS:
1. Digoxin.
2. Toprol.
ALLERGIES: None.
SOCIAL HISTORY: The patient denies tobacco use. Occasionally, the patient drinks alcohol.
FAMILY HISTORY: The patient’s mother has had a history of hypertension and patient’s grandfather has had a history of coronary artery disease.
REVIEW OF SYSTEMS: All systems are reviewed and otherwise negative.
PHYSICAL EXAMINATION:
VITAL SIGNS: BP 148/104, temperature 98.8, pulse 198, respirations 16, O2 sat 97% on room air.
GENERAL: The patient is a well-developed (XX)-year-old who appears anxious.
HEENT: Moist mucous membranes.
NECK: Supple, no JVD.
HEART: Tachycardic, otherwise regular rhythm. S1 and S2.
LUNGS: Clear to auscultation bilaterally.
ABDOMEN: Nontender, obese.
EXTREMITIES: No clubbing, cyanosis or edema.
LAB AND DIAGNOSTIC DATA: Chest x-ray shows no acute findings by our reading. EKG shows a supraventricular tachycardia with a rate of 210. No acute findings on our reading. Troponin normal. WBC 14.8, otherwise normal CBC. Digoxin level 0.5. Chem-7 is normal except for a glucose of 116.
EMERGENCY DEPARTMENT COURSE: The patient was seen and examined. An IV was established in his left antecubital region. He was found to be in supraventricular tachycardia. He was given 6 mg of adenosine without conversion. He was given a repeat dose of 12 mg without conversion. The patient was bolused with Cardizem 20 mg and started on a drip at 15 mg an hour. He was rebolused with 25 mg of Cardizem. His rate began to come down into the 150s range and then he converted into a sinus rhythm. The patient’s old charts were reviewed. We did discuss the patient with Dr. John Doe who is covering for his cardiology group, and the patient was discharged in good condition.
MEDICAL DECISION MAKING: The patient is a (XX)-year-old male with a supraventricular tachycardia. We will discharge him to home. He is to take his medications as directed. He is to follow up with the heart clinic and return if worsened symptoms.
DISPOSITION: The patient was discharged to home.
DIAGNOSIS: Acute supraventricular tachycardia, resolved.
