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Sinus Tach on DOT Physical

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Just looking for input on how you address someone with Sinus Tachycardia on DOT PE.  

Obviously the medical examiner handbook has been removed for several years.

Nathalie Hartenbaum's book addresses just about every kind of tachycardia other than sinus tachycardia.

 

I had a patient today with pmhx anxiety well controlled on paroxetine for many years.  Initial HR was 124-128 manual.  At the end of the visit I had our office perform an EKG which showed Sinus Tach rate 106.  I took her HR again on the way out and it was 96.  (The patient denied CP, palpitations, syncope).  

A copy of the EKG was faxed to her PCP.  

 

Safe to attribute to anxiety?  Require a letter from a Cardiologist?  Give a 6 month card?  1 year card?  2 year card?

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I'd probably require a cardiology clearance, issue 1 year card after that.  If a visit to your office causes that, what else might? And what all has that anxiety/tachycardia done in cumulative damage over the years?

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