I was working morning shift that day when my colleague passed over a pending night case. I That was my earliest day of returning to work after 2 weeks of quarantine as I became close contact to 2 positive Covid19 colleagues. Alhamdulillah my swabs turned out to be negative and I need to be non-symptomatic and complete 2 weeks of quarantine.
So, this young lady (Miss A) was in her 20s, with no underlying diseases, presented to us with palpitation and no other symptoms. Basically palpitation is an uncomfortable feeling that the heart is racing or the heart beats too fast. Same feeling when you are about to receive your exam results, or maybe when you see your crush walking around. :)
This same feeling is normal to me ever since I started working too. Haha. Nak masuk kerja selalu nervous sebab tak boleh nak expect much apa akan jadi sepanjang shift. So, I will always expect the worst situation so that I can get more prepared.
Okay, back to the patient.
Palpitation is normal is you feel it after a sprint or physical activities
It is also normal if you are stressed or anxious about anything.
Not to forget, if you drink alcohol or caffeine.
Why? your heart is pumping blood more frequently to the rest of the body to support it. :)
However, if you came to the hospital because of this, the health care staff will definitely need to rule out the emergency causes especially the heart problem. Along with palpitation, you definitely need to visit your doctor if you ALSO feel difficulty to breath / dizziness / collapse / fainting.
For this patient, some blood investigations will be taken - usually:
- full blood count (FBC) - we can see if there is any low hemoglobin, so it can be a sign that your body does not receive enough oygen.
- renal profile (RP) - to check your baseline for kidney function
- cardiac marker (in my hospital setting, we will take troponin I) - here, it can show if there is any problem with your cardiac (heart) muscles, maybe the muscles also do not receive enough oxygen and start to break down.
- electrocardiogram (ECG) is a must - this can show the rhythm of your heart, is the conduction of impulse okay or not
For Miss A, the blood results turned out to be normal and serial ECG was normal (improving sinus tachycardia, without ischemic changes going on)
Back to the history that we already taken at the beginning, she admitted that she drank lots of coffee during this Movement Control Order (MCO). She claimed that prior to this, she drink a cup of coffee as usual and she denied having this symptom.
To my surprise, during MCO, her caffeine intake was 4 TIMES DALGONA COFFEE A DAY!
If I use the viral Dalgona Coffee's recipe, it mentioned to use 2 sachet of Nescafe for one drink. So can you imagine how much sachets she drank a day? T_T
Diagnosis: Palpitation secondary to Caffeine
We re-accessed her after a while and decided to discharge her after she claimed her symptom is much improving and she looked very comfortable. We as well advised her to reduce caffeine intake and to come to ED urgently if she developed any other symptoms (especially chest pain / shortness of breath etc)
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I know that we are encouraged to give all out in everything we do, but please do not jeopardize our health. Okay?
SM, Perak, Malaysia
200502
