Our patient is a 29-year-old woman with a chief complaint of recurrent palpitations increasing in frequency over the past six months.
The pertinent features of her history include the following: a heart murmur was noted for the first time at age five, although no limitation of activity was advised. Her parents were told that she would outgrow it. Her subsequent growth and development were entirely normal.
During two pregnancies at ages 22 and 25, a heart murmur was heard, although no cardiac symptoms were noted. Because her heart murmur persisted, six months after her second pregnancy, her primary care physician ordered a chest X ray and electrocardiogram. She was informed that on chest X ray, her heart was mildly enlarged and that her electrocardiogram was abnormal.
Although she was advised to do so, she declined follow-up evaluation with a cardiologist.
She continues to exercise with no limitation. She does note paroxysmal episodes of palpitations, each lasting less than ten minutes, that are unrelated to any activity.
There is no history of rheumatic fever, cyanosis nor squatting, chest pain, syncope nor dyspnea. She has no family history of heart disease nor risk factors for coronary artery disease.