Patient Three
A 30-year-old woman presented to her Family Medicine physician with complaints of increased sweating (even in relatively cool surroundings), diarrhea, unexplained weight loss, insomnia, and feelings of anxiety. Her friends also had asked her whether she was worried, because her eyes seemed bulging out always. Her physician shook her hand and told her that everything would be okay. He noticed that her hand was shaking and her palm felt sweaty. Vital signs included a heart rate of 168, and blood pressure of 149/92. Her EKG was normal other than the rapid heart rate, and showed normally narrow QRS complexes. A physical exam finding gave the physician a big clue as to what was wrong with this woman.
The heart of a human is a muscular organ of the circulatory system, pumps blood throughout the body constantly. The size of the heart is approximately the size of a clenched fist and weighs between 7 to 15 ounces (200 to 425 grams). The heart is composed of cardiac muscle tissue that is very strong and able to contract and relax rhythmically throughout a person’s lifetime. It has an electrical conduction system, network of nerve fibers that coordinates the contraction and relaxation of the cardiac muscle tissue to obtain an efficient and wave-like pumping action of the heart.
The resting pulse rate is the rate of the heartbeat when the body is at rest. According to the National Institutes of Health (NIH), resting pulse rates within a normal range is an indication of good health. The normal resting rate of women is not different from men. The normal resting pulse rate is from sixty to one hundred beats per minute. Any female over ten years of age fall within the range on resting pulse rate as indicated. The normal sinus rhythm is the normal rhythm of the heart. A faster pulse rate than normal heart rate is considered as a tachycardia. If a person has a tachycardia, the rate on both the upper chambers and lower chambers of the heart are increased significantly. If there is an abnormality in the heart that produces rapid electrical signals then the person has a tachycardia. In an electrocardiogram (ECG), the criteria for a normal sinus rhythm includes; a heart rate between 60 to 100 beats per minute, its regularity is regular, “P”wave is present for every “QRS” complex in ratio of 1:1), PR interval is between 0.12 second and 0.20 second, and QRS complex width is less than 0.12 second respectively. The physiological phenomenon variation in the time interval between heartbeats is the heart rate variability (HRV).
In the case of the 30-year-old woman, caution from NIH, it is an indication of high blood pressure since her blood pressure is 149 over 92 and her pulse rate is above 100 that is, her pulse rate is 168 beats per minute. The patient is suffering from tachycardia because her pulse rate is faster than a normal heart rate and rapid pulse rate is one of the symptoms of tachycardia. The patient’s heart rate or rhythm deviation is physiologic. Based on the patient’s complaint, she has the feeling of anxiety. This is related to emotional arousal in which a person has a variation in the time interval between heartbeats under HRV. It is a state of anxiety that causes an increased of sweating. In addition, the patient has an anxiety disorder that causes her from diarrhea, concentration difficulties, and insomnia. Anxiety can be treated medically, psychological counseling or independently. The best thing to do is to treaty anxiety by self-treatment through exercise, meditation, and talk to the person who is supportive enough.
References
Severson, D. (2011). Live Strong. Pulse Rates: Normal Resting Pulse for Women, Retrieved
Texas Heart Institute (2013). Heart Information Center: Anatomy of the Human Heart, Retrieved
