54-year-old white female with palpitations.
History of Present Illness: This 54-year-old white female, a computer programmer, presented at her physician's clinic with recent onset of "heart-pounding." She described the episodes as a feeling of fullness in her neck and a racing heart. The events do not seem to be triggered by stress or physical exertion and have occurred at all times during the day and night. She estimated that they occur about 10 times a day. The palpitations last about 5 minutes and then subside and are not associated with chest pain or shortness of breath.
In addition to the palpitations, she complained of increasing irritability and difficulty concentrating at work, both of which have become noticeable over the past 12 months. She described herself as having always been "the nervous type," but over the past year, a tremor in both hands has made it difficult for her to use a keyboard. In addition, she reported a loss of weight in the past three months (116 lbs. to 104 lbs.) despite an increase in her appetite. She complained of mild insomnia and noticed that recently she has been uncomfortable at night when there are lots of covers over her. She denied any history of depression or anxiety disorders and reported that she does not smoke, drink coffee, or take any diet medications or other prescription or non-prescription drugs.
Past Medical History: The patient has been in relatively good health most of her life. However, she reported an episode of unexplained weakness in her right leg about 5 weeks ago. The symptoms only lasted "a few hours" and then went away. She sought no medical attention at that time. She has not had a recurrence of this since that time.