Palpitations - Lacrosse

HISTORY: A 22-year-old male division 1 collegiate lacrosse player noted palpitations as his heart rate abnormally increased during practice. It continued to remain elevated during practice even during periods of rest. Despite this, he was able to complete practice. He denied chest pain or dyspnea. As the athletic trainer noted an erratic heart rate, the athlete was sent to the emergency department where he was admitted to the hospital for further evaluation. PHYSICAL EXAM: Physical exam demonstrated patient was in no acute distress and was alert and oriented to person, place, and time. Strength and sensation were intact of all extremities.On auscultation of his heart, his rhythm was irregular. No murmurs, rubs, or gallops were appreciated. His pulmonary effort was normal and his lungs were clear to auscultation bilaterally. DIFFERENTIAL DIAGNOSIS: 1.Atrial Fibrillation 2.Supraventricular Tachycardia 3.Sinus Arrhythmia 4.Increased burden of Premature Ventricular Contractions (PVCs) 5.Anxiety TEST AND RESULTS: -Normal TSH -Normal CMP -Normal CBC-Normal Urine Toxicology screen -EKG and Telemetry with Atrial Fibrillation without rapid ventricular rate. -Normal Transthoracic Echocardiogram with Ejection Fraction of 60-65%-CHADSVASC score = 0 FINAL DIAGNOSIS: Paroxysmal Atrial Fibrillation TREATMENT and OUTCOMES: 1.Plan was for inpatient cardioversion; however, patient spontaneously self-converted to sinus rhythm within 48 hours. 2.Was briefly placed on Eliquis but was discontinued on discharge3.14 day Holter Monitor outpatient was unremarkable4.Patient declined recommended outpatient Electrophysiology Study (EPS) and Catheter Ablation. 5.Referral placed to Genetics. Patient declined outpatient consultation. 6.Recommend ownership of smart device with EKG capabilities to capture any potential future episodes.7.Patient returned to sports and has been without further episodes of Atrial Fibrillation or palpitations.