Station - Instructions for candidate
You are a medical student on placement in a general practice in Mandurah.
Sonia Petrakis, a 42-year-old school office manager, has come back for the results of the heart tests the GP arranged for her palpitations. The results are printed on your sheet. The GP has asked you to see her, go through the results with her and agree a plan.
24-hour Holter monitor report
| Item | Value | Reference range |
|---|---|---|
| Underlying rhythm | Sinus rhythm throughout; heart rate 52-138 /min (mean 76) | Sinus rhythm |
| Ventricular ectopic beats | 2,900 in 24 hours (3.2 percent of beats); single morphology; no couplets; no runs beyond 3 beats | Burden under 10 percent generally benign in a normal heart |
| Supraventricular ectopic beats | 180 in 24 hours; no runs | Occasional |
| Pauses and conduction | No pauses over 2 seconds; PR and QRS normal throughout | No pauses over 3 seconds |
| Symptom diary correlation | All 11 diary entries ('thump', 'skipped beat') correspond to isolated ventricular ectopics; most entries between 8 pm and midnight | n/a |
Reported by the cardiology service; no further action recommended in the absence of structural heart disease.
Echocardiogram, resting ECG and bloods
| Item | Value | Reference range |
|---|---|---|
| Echocardiogram | Normal left ventricular size and systolic function, ejection fraction 62 percent; normal valves; no regional wall motion abnormality; normal right heart | Ejection fraction over 55 percent |
| Resting 12-lead ECG | Sinus rhythm 72; PR 150 ms; QRS 84 ms; QTc 420 ms; no pre-excitation; one ventricular ectopic captured | Normal |
| TSH | 1.4 mIU/L | 0.4-4.0 mIU/L |
| Haemoglobin | 132 g/L | 115-160 g/L |
| Potassium and magnesium | 4.2 mmol/L; 0.85 mmol/L | 3.5-5.2; 0.7-1.1 mmol/L |
All arranged by the GP after the first consultation three weeks ago.
Your tasks are to:
- Take a focused history.
- Interpret the results provided.
- Explain the results to Mrs Petrakis.
- Outline your initial management plan to her.
- You do NOT need to examine the patient.
- You do NOT need to summarise your findings to the examiner.
This is a 10-minute station, with 2 minutes of reading time.