FEATURE: LAURA GILLEN, PA-C; TYGER MEADE CLAYTON, MPA, PA-C
Clinical Challenge: Unexplained Tachycardia in 24-Year-Old Woman The patient experienced random short bursts of chest pain and felt that she was going to pass out, starting 2 weeks before ED visit.
© B. BOISSONNE T/ SCIENCE SOURCE
A
The wide variety of symptoms often masks diagnosis of POTS.
24-year-old woman presents to the clinic for follow-up after an emergency department (ED) visit for chest pain and lightheadedness. The patient, a student at a local university, reports that she was studying at the library with a friend when she suddenly felt her heart begin to race and felt “like she was going to pass out.” She says that the chest pain and lightheadedness began 30 minutes before her near-syncope. The patient experienced random short bursts of chest pain starting 2 weeks before the ED visit. However, she describes her current pain as constant (not short bursts), located on the left side of her chest, and so severe (sharp and stabbing pain) that it makes it difficult for her to catch her breath while speaking. The earlier episodes (short bursts of chest pain) seem to have been aggravated by stress or after transitioning from a sitting to a standing position.The patient has not tried anything to alleviate her symptoms. During the ED visit, the patient rated her chest pain as 7 on a scale of 1 to 10, with 1 being very little pain and 10 being the worst pain she has felt in her life. The patient was admitted for chest pain, palpitations (racing, skipped beats), dizziness, and shortness of breath. However, at the clinic visit, the patient denies having experienced any chest pain, dizziness, palpitations, chills, night sweats, fatigue, or weight changes. She also denies chest tightness, edema, decreased endurance, cough, or dyspnea. Continues on page 20
18 THE CLINICAL ADVISOR • SEPTEMBER/OCTOBER 2021 • www.ClinicalAdvisor.com
