Document Type: Cardiology General OP Provider Note   Document Subject: AMB Cardiology Progress Note   Performed By: on May 22, 2021 12:15 EDT   Verified By: on May 22, 2021 12:15 EDT   Encounter Info: Outpatient, 05/17/21 - 05/17/21    * Final Report *        Reason for Consultation   Follow up palpitations. States she has palpitations at night when she's resting and episodes are increasing.   History of Present Illness/Subjective     A 30-year-old female who presents today for palpitations.   She complains of feeling occasional sensations of her heart stopping and starting and occasionally "fluttering". She notes her symptoms typically are worse at night when she lays on her right side. She complains of some associated shortness of breath but denies any dizziness or near syncope. She has actually been having symptoms for over a year. She was evaluated by Dr. in February of 2020 for her palpations. At that time, she attributed most of her symptoms to anxiety and was admittedly drinking more alcohol and caffeine than usual. She cut back on her consumption and her anxiety improved and she her palpitations were manageable. for She denies any chest pain, lower extremity edema, orthopnea or PND. She has no history of tobacco or illicit drug use.  Family history is noncontributory.  Review of Systems     Constitutional:  No fevers,  no chills Eyes:  No changes in vision Ears, Nose, Mouth, Throat:  No sore throat Respiratory:  No shortness of breath,  no cough Cardiovascular:  No chest pain,  no edema, + palpitations Gastrointestinal:  No abdominal pain,  no nausea,  no vomiting,  no diarrhea Genitourinary:  No dysuria,  no hematuria Endocrine:  No polyuria,  no polydipsia Musculoskeletal:  No arthralgia,  no myalgia Skin:  No rash Neurologic:  No headache,  no focal weakness  Physical Exam/Objective  Vitals & Measurements last 24 hours  VITAL SIGNS  Heart Rate:       94 bpm  BP #1:       110 / 72 mmHg  SpO2 (%):       98 %     No qualifying data available.      Constitutional:  No acute distress,  well-nourished Eyes:   normal conjunctiva,  no scleral icterus Neck:  Supple, non-tender, intact range of motion, no JVD Respiratory:  Lungs CTAB Cardiovascular:  Regular rate and rhythm, no murmur/gallop/rub, normal S1 S2, no lower extremity edema Gastrointestinal:  Soft, non-tender, non-distended Musculoskeletal:  No joint swelling, no deformity, intact ROM Integumentary:  Intact, warm, dry no rashes Neurologic: Alert & Oriented x 3, no cognitive impairment,  no focal deficits Psychiatric:  Cooperative, appropriate mood and affect         Assessment/Plan       Palpitations   R00.2   Based on her description, I suspect these are related to PACs vs PVCs. This is now her second time being evaluated by cardiology for her palpitations. Will place 48 hour monitor to further quantify her ectopy. Could consider low dose propranolol given her history of anxiety which seems to exacerbate her palpitations. Reassurance provided today that based on her description, her palpitations are most likely benign in etiology.     Chronic Problem List    Allergic rhinitis  Anxiety  Anxiety disorder, unspecified  Chronic GERD  Chronic pansinusitis  Chronic sinusitis  Chronic suppurative otitis media of both ears  Conductive hearing loss, bilateral  Depression  Encounter to establish care  FHx: ovarian cancer  Hearing loss  Hypertrophy of both inferior nasal turbinates  IBS (irritable bowel syndrome)  Intracranial mass  Irritable bowel syndrome with constipation  Irritable bowel syndrome with constipation and diarrhea  Nasal obstruction  Nasal septal deviation  Nasal turbinate hypertrophy  Ovarian cyst  Pelvic fullness  Post-nasal drip  Surveillance for birth control, oral contraceptives  Procedure/Surgical History  Influenza vaccination (10/21/2020) Gynaecologic examination (12.2019) egd (10/04/2010) BMT Ear Surgery Eye Muscle Surgery   Medications  Home Medications (4) Active Buspirone 10 mg oral tablet See Instructions, 1/2 tablet BID Lamotrigine 25 mg oral tablet See Instructions, TAKE ONE TABLET BY MOUTH DAILY FOR 2 WEEKS THEN TAKE ONE TABLET BY MOUTH TWICE A DAY FOR 2 WEEKS (TAKE AT NIGHT MIGHT CAUSE SLEEPINESS) Lamotrigine 25 mg oral tablet 25 mg = 1 Tablet, Orally, Daily Prevacid 30 mg oral delayed release capsule 30 mg = 1 Capsule, Orally, BID  Allergies   Animal Dander (Unknown)  Biaxin (Difficulty Breathing)  Keflex (Hives)  Pollen (Unknown)  cephalosporins (Rash)  levofloxacin (Rash)  penicillins (Rash)  sulfa drugs (rash)  Social History    Alcohol   Current, 1-2 times per week   Substance Abuse   Denies   Tobacco   Tobacco Use: Former Smoker.  Family History   Breast cancer: Grandmother (P).  Coronary artery disease..: Grandfather (M) and Grandmother (M).  Diabetes mellitus: Negative: Mother, Father, Sister, Grandfather (M), Grandfather (P), Grandmother (M) and Grandmother (P).  Ovarian cancer..: Sister and Grandmother (P).  Stroke: Grandmother (M).  Lab Results   Hematology results most recent last 24 months  Hgb: 13.4 GM/dL (11/25/19 18:14:00)  Hct: 39.2 % (11/25/19 18:14:00)  Platelet: 218 k/cumm (11/25/19 18:14:00)  Chemistry results most recent last 24 months  Sodium SerPl QN: 141 mmol/L (11/25/19 18:14:00)  Potassium SerPl QN: 3.8 mmol/L (11/25/19 18:14:00)  BUN SerPl QN: 7 mg/dL (11/25/19 18:14:00)  Creatinine SerPl QN: 0.78 mg/dL (11/25/19 18:14:00)  ALT SerPl QN: 15 Units/L (11/25/19 18:14:00)  AST SerPl QN: 18 Units/L (11/25/19 18:14:00)  Cardiac Enzymes results most recent last 24 months   No qualifying data available.  Lipid results most recent last 24 months   No qualifying data available.           Signature Line Electronically Signed on 05/22/21 12:15 EDT ________________________________________________________ NP