Our patient is a 30-year-old woman with a chief complaint of episodic palpitations of one year duration, with a recent increase in frequency.
The pertinent features of her history include the following:
Over the past year, she has had brief “flip flop,” or “skipping,” sensations in her chest. Each lasts a second, but they tend to come and go over several minutes. They are not related to exertion. She is able to run 3 miles per day without any palpitations or other symptoms. She has also noted chest pains that are sharp, non-exertional, and last only a few seconds.
A murmur was noted when she was fifteen on an examination to participate in high school athletics. She was told that she would outgrow it.
There is no history of rheumatic fever, lightheadedness or syncope, chest trauma, drug abuse, or risk factors for coronary artery disease. She takes no medications and denies excessive use of caffeine.