Rosalina's Palpitations

Name	Rosalina Frederic
DOB	25/06/1984 (31 years)
Occupation	Taxi driver
History	I feel my heart race and thump in my chest every once in a while. It lasts about half a minute. I feel dizzy and get some chest pain and shortness of breath. Once I actually fainted when it happened! This was very embarrassing as it occurred whilst I was in a supermarket. They occur in random locations and there isn\'t a specific trigger. The symptoms go when my heart stops racing. I avoid exercising in case that sets it off. Do you think I should avoid exercising? I deny any other symptoms.
Past Medical History	Nil
Drug History	Nil
Family History	Nil
Social History	Non-smoker. Occasional alcohol. 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 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 (Paroxysmal supraventricular tachycardia, Arrhythmia, Anxiety)	0	1