Warren Waterford

A 35-year-old male accountant presents to general practice with a 2-week history of intermittent, self-terminating palpitations — sudden-onset rapid, forceful, irregular heartbeat lasting a few minutes, precipitated by caffeine, with transient dizziness and sweating but no chest pain, breathlessness or syncope. Working diagnosis is paroxysmal supraventricular tachycardia; atrial fibrillation/flutter, ventricular arrhythmia, thyrotoxicosis, anxiety and stimulant/drug causes must be considered and excluded.