ATTENTION: On Friday, January 13 6 PM ET – 10 PM ET the site may be unavailable for up to one hour due to maintenance. We apologize for the inconvenience.
This article has no abstract; the first 100 words appear below.
Foreword
In this Journal feature, information about a real patient is presented in stages (boldface type) to an expert clinician, who responds to the information, sharing his or her reasoning with the reader (regular type). The authors' commentary follows.
Stage
A 51-year-old woman presented to her local emergency room with a 6-month history of intermittent palpitations, which had worsened that day. She described her pulse as fast (it was approximately 140 beats per minute) but regular. She also reported recent worsening fatigue, heat intolerance, and an 18-kg (40-lb) weight loss despite a good appetite. She reported no dyspnea, orthopnea, syncopal episodes, headaches, tremors, or profuse sweating. She did not have a history of cardiovascular disease.
Response
The patient's pulse of 140 beats per minute is consistent with sinus tachycardia. The occurrence of palpitations in a relatively young woman without . . .
Dr. Malabanan reports receiving speaker's bureau fees from Novartis and Procter & Gamble/Sanofi-Aventis. Dr. Pearce reports receiving compensation from DuPont for testimony for the defense regarding the development of hypothyroidism after exposure to radioactive iodine released by the Hanford Nuclear Reservation.
Disclosure forms provided by the authors are available with the full text of this article at NEJM.org.
No other potential conflict of interest relevant to this article was reported.
We are indebted to Dr. Susan Bergman, who referred this patient to us.
Source Information
From the Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center and Boston University School of Medicine (P.P., A.M.L., E.N.P., L.E.B.); and the Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center (A.O.M.) — all in Boston; and the Department of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand (P.P.).
Address reprint requests to Dr. Braverman at the Section of Endocrinology, Diabetes, and Nutrition, Boston Medical Center, 88 E. Newton St., Evans 201, Boston, MA 02118, or at This e-mail address is being protected from spambots. You need JavaScript enabled to view it .
HEPATITIS-B-VACCINES
CKD-Micro1
CKD Algorithm