Clinical Insights
Visit Date: Oct 24, 2024 • 09:41 AM
SOAP Notes
Patient reports episodic chest tightness and "skipping" heart sensations. Symptoms worsened under high-stress work conditions. Denies radiating pain to left arm.
Vitals: HR 112 bpm (tachycardic), O2 98% (stable). AI-analysis of audio markers confirmed speech tremors and irregular respiratory rhythm during description of symptoms.
Symptoms consistent with sinus tachycardia secondary to acute anxiety. Arrhythmia detected via mobile telemetry requires secondary 12-lead ECG confirmation.
Recommended Plan
Diagnostics: Order 12-lead ECG and 24-hour Holter monitor to rule out paroxysmal AFib.
Immediate Action: Referral to behavioral health for anxiety management strategies.
Follow-up: Review results in 7 days. Patient instructed to use "Emergency" trigger if pain radiates.