Warren Waterford

A 35-year-old man presents to the GP clinic with a 2-week history of intermittent palpitations — a sudden racing, thumping heartbeat that skips a beat, lasting a few minutes and triggered by caffeine. Take a focused history, verbalise a relevant examination, order appropriate investigations, give a diagnosis with differentials, and outline a management plan.

1. 1Take a focused history of the palpitations using SOCRATES
2. 2Screen for and exclude cardiac red flags (chest pain, breathlessness, syncope)
3. 3Explore past medical, drug, family and social history including caffeine, alcohol and smoking
4. 4Verbalise a focused cardiovascular examination to the examiner
5. 5Order and justify appropriate investigations including an ECG
6. 6State a working diagnosis of SVT with relevant differentials
7. 7Explain the diagnosis and outline a management and safety-netting plan to the patient