A 56-year-old woman has woken up 5 times in the last month with a feeling of thumping in her chest. On sitting up for about 2 minutes and taking a few deep breaths, the sensation subsides over a further minute. Her ECG shows sinus rhythm.
A. Cardiac enzymes
B. Electrocardiogram
C. Echocardiogram
D. 24 hour ambulatory taped electrocardiogram
E. Serum urea and electrolytes concentration
Ans. The key is C. Echocardiogram. [This is orthopnea of heart failure and arrhythmia related to heart failure or overload from venous pooling can cause palpitation or even thumping in chest. As it occurs in night most likely it is orthopnea not due to other aeitiology!! To check the cardiac functional status we should do echocardiography