21-Year-Old Woman With Palpitations and Vomiting

Abstract

© 2010 Mayo Foundation for Medical Education and Research A 21-year-old woman presented to the emergency department with chest palpitations, nausea, and vomiting of 6 hours' duration. Her symptoms originated as a bandlike tightness across the sternum that progressed to include a racing heart with “skipped beats.” She then began to feel nauseous and experienced more than 10 episodes of vomiting. She described the emesis as watery without any signs of blood with eventual progression to retching without output. Before experiencing these symptoms, she had slept for 6 hours without difficulty and had no symptoms entering into sleep. Her medical history was notable for 2 uncomplicated vaginal deliveries. She reported no surgical or psychiatric history. She did not use prescription medications. Although she lived with her mother and 2 children, she spent several nights per week at friends’ homes. During these nights, she drank up to 10 shots of liquor (estimated at 148 mL [5 oz] of alcohol) and occasionally used illicit drugs, including marijuana and cocaine. Physical examination yielded the following vital sign information: heart rate, 120 beats/min; blood pressure, 118/82 mm Hg; respiration rate, 19 breaths/min; and temperature, 36.5°C. The patient appeared uncomfortable. Cardiac examination revealed a regular, rapid tachycardia without murmur or extra heart sounds. Findings on lung and abdominal examinations were unremarkable, as were the remainder of the examination results. Laboratory tests yielded the following results (reference ranges provided parenthetically): hemoglobin, 12.9 g/dL (12.0-15.5 g/dL); white blood cell count, 12.3 × 10/L (3.510.5 × 10/L); lactate, 3.6 mmol/L (0.6-2.3 mmol/L); and unremarkable levels of electrolytes, creatinine, troponin I, and D-dimer.