Location for this role play: General Practice

• The student has been asked to take a history from a simulated patient
• Please kindly follow the script to simulate the consultation
• You will not be expected to undertake an examination
• Please answer in the negative to any specific questions about your condition where the answer is not outlined in the script

Your symptoms first started about 3 months ago.

You explain that you’ve been experiencing episodes where your heart goes from a normal rate to beating very forcefully and quickly. The episodes begin abruptly, as if a “switch had been flipped”, and stop just as quickly. During these episodes, you feel as though your heart is pounding in your chest.

If asked specifically to “tap out” your palpitations:

Tap a very rapid,

regular

rhythm. A similar tempo to the songs

Mr Brightside

or

Don’t Stop Me Now

would be appropriate (these examples are for your reference only; no need to mention them to the student).

If asked specifically, you think the heart is beating regularly when this happens, and you don’t recall any missed beats.

These episodes typically last for a couple of minutes before stopping on their own. They occur about once or twice a week. You feel fine between episodes, but they’re frightening when they happen.

You can’t identify any specific triggers for them – they can happen at any time, even when you’re resting. You drink quite a lot of caffeine – up to 4 cups of coffee a day – but haven’t noticed any association between food or drink and your symptoms.

Concerningly, you experienced a loss of consciousness two days ago after your usual evening jog. As you finished running and were walking to cool down, you suddenly felt your heart racing and pounding. This was quickly followed by light-headedness and sweating.

The next thing you remember is waking up on the ground, accompanied by a concerned passerby. You felt confused for a minute or so after regaining consciousness and then returned home safely.

Since the collapse, you have been feeling well and have not experienced any other concerning symptoms.

• ••• If specifically asked: you did not bite your tongue or experience any jerking movements.
• You did not lose control of your bladder or bowels.
• No recent head injuries or infections.
• No chest pain or shortness of breath before collapsing.

• Ideas: You initially dismissed your palpitations as anxiety related – work has been quite stressful recently with deadlines. However, the recent episode of collapse has prompted you to attend the GP practice.
• Concerns: You are worried that something is wrong with your heart, and if these symptoms represent something dangerous.
• Expectations: You would like further investigations and checks around your heart.

• Asthma (well controlled; no inhalers needed for a couple of years)
• Appendicectomy two years ago (no complications)

• No regular medications
• No over-the-counter medications
• No illicit substances
• No known drug allergies

• Both parents alive and well, no major medical issues
• Sister fit and well
• Paternal uncle died suddenly at age 35 while playing football
• Paternal grandfather also died young (in his 40s) – cause unknown

• Unmarried; no current partner; no children
• Does not drive
• Lives with parents
• Non-smoker; does not drink alcohol
• Keeps fit – gym several times a week; enjoys running and park runs
• Eats healthily (few takeaways or fried foods)
• Journalist for the local paper – work can be stressful with deadlines but enjoys it; good support network

If the student asks about any other symptoms aside from those listed in the script above, please reply in the negative.

Clinical Skills Foundation Course · Phase 1 Term 3 · CVS Role Plays · Case last revised July 2026

• Presentation of palpitations ?cause. Discuss differentials. Most likely arrhythmia such as SVT (discrete episodes, sudden onset, fast and regular). Contrast with AF (irregular) and benign extrasystoles (short-lived ‘thumps’ without syncope).
• Palpitations assessment: duration, frequency, nature – ask patient to tap out rhythm, associated symptoms, triggers, cardiac history, medications, alcohol/caffeine/illicit substances.
• Syncope assessment: associated symptoms, duration of LOC and recovery, absence of seizure-like activity or prolonged confusion.
• Red flags: onset with exercise, associated breathlessness/chest pain/syncope, past cardiac history, family history of sudden death under 40 or cardiomyopathy.
• Investigations: 12-lead ECG, bloods (anaemia, electrolytes, thyroid), ambulatory ECG (Holter / event recorder / implantable loop recorder), echocardiogram.
• Note that examination and resting ECG are likely normal between episodes.
• Driving: DVLA – Group 1 must stop driving if arrhythmia has caused/is likely to cause incapacity.
• Safety-netting: avoid strenuous exercise until evaluated; seek immediate medical attention for recurrent syncope or sustained palpitations; importance of follow-up and adherence to investigations.