American College of Physicians: Internal Medicine — Doctors for Adults ®

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The MKSAP Challenge

From the July-August ACP Observer, copyright 2004 by the American College of Physicians-American Society of Internal Medicine.

Clinical scenario

A 20-year-old college student is evaluated for palpitations. She has noticed a rapid pounding in her chest on several occasions, which she first noticed in middle school.

Most episodes last less than 1 minute, but a few have lasted one-half hour. During an episode, she feels lightheaded, but is not short of breath and does not have syncope or chest pain. She is most aware of the pounding sensation in her neck. Symptoms usually occur without warning while she is at rest. If she breathes slowly and deeply, the episodes usually stop on their own. They have never interfered with her activities, and she continues to run cross-country.

Recently, the episodes have been longer and more frequent. She has never had the rhythm documented. Physical examination and electrocardiogram findings are normal. She has no family history of heart disease.

Which of the following is the most likely diagnosis?

A. Benign premature atrial contractions
B. Palpitations related to mitral valve prolapse
C. Paroxysmal supraventricular tachycardia
D. Ventricular tachycardia
E. Paroxysmal atrial flutter

Answer

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