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Problem
9.1
Cardiologists
at a university clinic review the reasons for referral over the
past 5 years and discover palpitations to be one of the most common
reasons, second only to chest pain. They decide to do a prospective
study of the next 100 patients referred for palpitations.
The third
patient has a 24-hour ambulatory electrocardiographic (Holter)
monitoring test performed along with a diary to record when palpitations
are experienced. The results are:
- Nonsustained
runs of supraventricular tachycardia which are sometimes associated
with palpitations, and sometimes not;
- Episodes
of palpitations (on the symptom diary) which are sometimes associated
with supraventricular tachycardia and sometimes with normal
sinus rhythm.
On a structured
psychiatric interview, the patient also meets criteria for panic
disorder and somatization disorder. The rest of the patient interview,
physical examination, laboratory and cardiac evaluation is normal.
Question
9.1
| The
etiology of the patient's palpitations is most likely |
 | Cardiogenic
(i.e. supraventricular tachycardia) |
 |
Psychogenic (i.e. panic disorder and/or somatization disorder) |
 |
Both cardiogenic and psychogenic |
 |
Uncertain |
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