Kristeen's Palpitations

Name	Kristeen Alexandre
DOB	27/04/1989 (26 years)
Occupation	Porter
History	I feel my heart race and thump in my chest on a regular basis. If asked directly, it feels regular and occurs around 3-4 times per week lasting less than half a minute. It usually happens around 11am whilst I have been at work for an hour or two. If asked directly, usually shortly after my second or third cup of coffee. I am otherwise well with no chest pain, dizziness, shortness of breath or other symptoms.
Past Medical History	Diabetes which is well controlled with medication
Drug History	Metformin
Family History	If asked directly, mother had severe social anxiety. Otherwise nil
Social History	5 cigarettes per day. 5 units alcohol per day. No recreational drug use.

Introduces self	0	1
Confirms name & age of patient	0	1
Explains reason for consultation & builds rapport	0	1
Gains consent	0	1
Asks open question	0	1
Establishes duration of episodes	0	1
Establishes frequency of episodes	0	1
Establishes whether regular or irregular rhythm (may be helpful to ask patient to tap out)	0	1
Asks for triggers (caffeine, alcohol, activity)	0	1
Asks how episodes end (sitting down, spontaneous, specific habit/compulsion)	0	1
Screens for associated symptoms: chest pain, shortness of breath, polyuria (arrhythmia)	0	1
Screens for hyperthyroid symptoms (weight loss, sweating, agitation, diarrhoea, feeling hot)	0	1
Screens for hypoglycaemic symptoms (hunger, sweating)	0	1
Screens for anxiety and associated symptoms (tingling, nausea)	0	1
Elicits past medical history (specifically cardiovascular disease, diabetes mellitus, hypertension, hyperlipidaemia, thyroid disease, anxiety)	0	1
Elicits family history (specifically asking for early cardiovascular disease, sudden death, arrhythmias, thyroid disease)	0	1
Elicits drug history (including use of salbutamol if asthmatic)	0	1
Checks for allergies	0	1
Checks if patient smokes or drinks	0	1
Asks if any history of illicit drug use	0	1
Asks about stress and the impact of symptoms on life and occupation	0	1
Explores and responds to ideas	0	1
Explores and responds to concerns	0	1
Explores and responds to expectations	0	1
Shows empathy	0	1
Avoids jargon	0	1
Summarises back to patient	0	1
Thanks patient	0	1
Patient global score	0	1	2
Gives reasonable differential diagnosis (Caffeine, Stress, Anxiety, Diabetes mellitus)	0	1