GetMeOuttaThisMess Posted October 7, 2020 Share Posted October 7, 2020 (edited) Wife got home yesterday and relayed some information to me regarding a co-worker who had sx. palpitations end of last week necessitating ED evaluation. Apparent "frequent PVCs" on ECG, which by history sounded like quadrigeminy. She was sent home and told to see her PCP regarding concern for cardiac ischemia. We stayed in touch with her over the weekend to make sure she was ok, though she has a paramedic boyfriend live-in who actually did a 12 lead on her as a walk-in at his station last Friday while he was on duty. Here is my concern. She sees PCP yesterday who says he suspects it's her thyroid replacement medication and says that the dosing needs to be cut back...without checking of lab. No baseline values. WTH are they teaching you young 'uns in school present day? Maybe it was the airline pilot in his 30's that I saw that had CM with development of VT followed by a piss pour response to his heart transplant which resulted in death back around '90 that makes me extra cautious with these folks. In my case, thyroid profile and a stress/echo (key word here is ECHO) are a minimum for this patient. Oh, and a FH of early CVD in a patient who is in her late 40's/50ish. Edited October 7, 2020 by GetMeOuttaThisMess Quote Link to comment Share on other sites More sharing options...
Administrator rev ronin Posted October 7, 2020 Administrator Share Posted October 7, 2020 Yeah, not how I would treat that in primary care. Why not a direct referral to cards? I absolutely would have *checked* the TSH, but not going to stop the workup there, no matter how much thyroid hormone she's on. Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 7, 2020 Author Share Posted October 7, 2020 I was told she’s HMO based insurance thus would’ve needed a PCP referral.Sent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 7, 2020 Moderator Share Posted October 7, 2020 Face Slap just a ? was it a doc pa or np? Quote Link to comment Share on other sites More sharing options...
GetMeOuttaThisMess Posted October 7, 2020 Author Share Posted October 7, 2020 Doc, so we were told.Sent from my iPhone using Tapatalk Quote Link to comment Share on other sites More sharing options...
Moderator ventana Posted October 8, 2020 Moderator Share Posted October 8, 2020 my work up shooting from limited clinical info long visit to discuss what happened review ER notes and findings EKG and rhythm strip for a few min with valsalva Holter for at least a week - ordered through my office no cards labs - kidney, cbc, lft, TSH, mag, lipids, FBS, urine ECHO if here anything on exam stress maybe if lipids awful, smoker, FMH, prior history close follow up if no contraindications start low dose beta met suc 25-50mg a day, asa 81 - to be revisited as work up proceeds yeah no where on this green earth would I do what the doc did, nope nada Quote Link to comment Share on other sites More sharing options...
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