Preparing for a cardiology visit
Heart palpitations and borderline blood pressure — follow-up
Patient: Emma Wilson, born 12 Jun 1989 (37 years) · Regular medication: levothyroxine 75 µg (morning, on an empty stomach); combined oral contraceptive pill
LOGISTICS (when booking the appointment): the referral for a 24-hour Holter ECG is in place — the recorder is usually fitted the day before
or on the day of the visit and returned the next day. When booking, agree the order with reception (Holter before the consultation, so the result is available at the visit).
Bring previous ECGs and the echocardiogram report.
1. Questions / topics to discuss
- Episodes of heart palpitations — lasting around ten to twenty seconds, mostly in the evening and under stress, perceived heart rate 130–150; they resolve on their own.
Is this supraventricular tachycardia or extra beats? What did the Holter capture and does it need further work-up?
- Borderline blood pressure (14-day averages: morning ~132/86, evening ~128/84) while on the combined pill.
Is the combined contraceptive safe at these readings, or should a different method be considered?
- Migraine with aura (a few times a year) and the combined pill.
I have read that aura plus oestrogens raise vascular risk — does that apply to me, and should I switch contraception?
- TSH 3.8 on levothyroxine, Hashimoto's thyroiditis.
Is the dose optimal, and could an under- or over-treated thyroid be making the palpitations worse?
- Ferritin 18, haemoglobin at the lower limit — iron deficiency.
Could iron deficiency explain the palpitations and fatigue? Should I take supplements, and at what dose?
- Coffee 3–4 times a day — with palpitations, should I cut down on caffeine?
2. Results to show bring printouts
| Lipids and thyroid |
|---|
| Total cholesterol | 198 mg/dl | borderline |
| LDL | 118 mg/dl | borderline (age/risk low) |
| HDL | 65 mg/dl | OK |
| Triglycerides | 92 mg/dl | OK |
| TSH | 3.8 µIU/ml | on levothyroxine — discuss |
| FT4 | 14.1 pmol/l | within range |
| anti-TPO | positive | Hashimoto's |
| HbA1c / glucose | 5.2 % / 88 | OK |
| Blood count and iron |
|---|
| Ferritin | 18 ng/ml | low |
| Haemoglobin | 12.4 g/dl | lower limit |
| Iron | 42 µg/dl | low |
| Potassium | 4.2 mmol/l | OK |
| Magnesium | 0.82 mmol/l | OK |
| CRP | <0.5 mg/l | OK |
| Blood count (apart from iron) | no abnormalities | OK |
Cardiology history: Echocardiogram — EF 62%, normal structure and valves. Previous Holter (2 years ago) — occasional supraventricular extra beats, no sustained arrhythmia. Blood pressure measured twice a day for 14 days (diary attached separately). Note: palpitations are more frequent on days with more coffee and less sleep.
3. Checklist — what to bring
- Printout of results — lipids and thyroid (TSH, FT4, anti-TPO)
- Printout of results — blood count, iron, ferritin
- Echocardiogram report (EF 62%) and previous Holter report
- Blood pressure diary — 14 days with a summary
- Referral / Holter ECG recorder
- List of medicines and supplements (below)
4. Medicines and supplements (if the doctor asks)
| Product | Dose / schedule | Notes |
|---|
| Levothyroxine | 75 µg in the morning, on an empty stomach | Hashimoto's; TSH 3.8 — to discuss |
| Combined contraceptive pill | once daily | to discuss in the context of blood pressure and migraine with aura |
| Vitamin D3 | 2000 IU | — |
| Magnesium + B6 | in the evening | ~120 mg of Mg ions |
| Omega-3 (EPA+DHA) | ~1000 mg daily | — |
| Iron | under consideration | only after the doctor's decision / confirmed deficiency |