Patient Instructions — SASHA MORONI

You are Sasha Moroni, 39 years old (choose appropriate DOB). You are slightly worried but not overtly anxious. You remain calm during the consultation. Your concern increases when discussing family history.

Opening statement: “I’ve been getting these episodes where my heart suddenly starts racing”

History of Presenting Complaint

You have experienced intermittent episodes of sudden-onset palpitations over the last 6 months.

Important features:

• Episodes start suddenly and stop suddenly without any clear trigger other than exercise (occasionally).
• Feels like “a switch being flicked”.
• Heart feels “very fast and pounding”.
• Episodes last around 10–20 minutes.
• Occur approximately once every 2–3 weeks.
• Most recent episode occurred while climbing stairs at work.
• You are not anxious and you are certain that neither anxiety nor stress is triggering these episodes.

Associated symptoms:

• Some Light-headedness during these episodes.
• Mild chest tightness (not pain) during some of the episodes but not all.
• One near-fainting episode 2 months ago after football (see below for more details).
• Mild shortness of breath during some of the episodes. You tend to stop in your tracks or sit down when you have this shortness of breath with the palpitations and wait for it to pass (within 10-20 mins).
• You have no symptoms between episodes.

The following parts of the history should ONLY be revealed if specifically asked:

Syncope / Presyncope: In response to “Have you ever lost consciousness or blacked out?”

• “I nearly blacked out once while I was playing football”
• You were playing football 2 months ago and while playing, you felt lightheaded as if you were going to faint. You sat down on the sidelines and then lay down on the floor for a few minutes. The palpitations subsided after about 5-10 minutes and then you slowly felt back to normal. You did not actually lose consciousness during that episode

Exertional Symptoms

• Episodes are sometimes triggered by exercise.

Family History

• Uncle (mother’s brother) died suddenly aged 41 while running.
• Family said it was “something wrong with his heart.”

Nature of Palpitations

• Sudden onset and sudden termination.
• Rapid pounding sensation.

Relevant Negatives

• No fever
• No recent illness
• No drug use
• No cocaine or recreational drugs
• Drinks 2 coffees/day
• Minimal alcohol (occasional at special events)
• No weight loss
• No tremor
• No excessive stress beyond normal work stress (You work as a Software Developer)
• Denies feeling anxious before episodes

Past Medical History

• Generally fit and well
• No known cardiac history

Drug History

• No regular medications

Allergies

• None known

Social History

• Non-smoker
• Exercises regularly
• Lives with partner

Ideas: “I wondered if it might just be stress.”
Concerns: “I’m worried because of what happened to my uncle.”
Expectations: “I’d like to know if this is dangerous.”

If Asked About Current Symptoms

You do not have any symptoms at present. Your last episode was last week.