History of Present Illness (HPI): The patient reports that the onset of her symptoms occurred approximately six weeks ago, coinciding with a stressful period when her in-laws moved to town and began building a house. She was heavily involved in coordinating between her in-laws and the building contractor, which she describes as a source of significant stress. The palpitations are described as “racing and fluttering” sensations with a pressure on her heart that radiates to her back and shoulder blades. The discomfort is typically rated as 3-4 out of 10 on a pain scale and occurs intermittently, with episodes lasting up to five minutes. The patient noticed that she often holds her breath during these episodes, which exacerbates the discomfort. When she becomes aware of this, she tries to take deep breaths, which provides some relief. She tried ibuprofen a few times, but it did not alleviate her symptoms. The patient expressed that she feels overwhelmed by her responsibilities, particularly the pressure of making decisions for her in-laws, which she fears may lead to their dissatisfaction. She has been feeling frustrated and irritated, especially when hearing complaints despite her efforts. She recognizes that she experiences irritation, nervousness, and hesitation during conversations with her in-laws and has been avoiding communication with them, even to the point of not wanting to answer the phone. Over the past two weeks, as her in-laws have been out of town and the house building project nears completion, she reports that her palpitations have become less frequent. Past Medical History:

• Gastroesophageal Reflux Disease (GERD): Controlled with a gluten-free diet due to her celiac disease.
• Celiac Disease: Managed with a gluten-free diet, which has resulted in increased energy levels but reduced appetite.
• Sleep Disturbance: Occasionally experiences difficulty sleeping, although this has improved in the past two weeks.

Review of Systems (ROS):

• General: Denies chills, sweating, or fever. Reports decreased appetite (+) and fatigue (+).
• HEENT: Denies congestion, ear pain, rhinorrhea, sinus pain, and sore throat.
• Respiratory: Negative for cough and shortness of breath.
• Cardiovascular: Negative for chest pain but reports occasional palpitations.

Additional Information:

• The patient denies the use of substances, including drugs or alcohol, and reports no history of substance withdrawal. She does not consume caffeine, does not smoke, and has no history of pulmonary obstructive disease. She denies the use of medications such as albuterol or decongestants, and there is no recent history of illness. The patient also denies any history of thyroid problems, and there is no family history of thyroid disease.

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Summary: This 45-year-old female presents with palpitations and a fluttering sensation that began six weeks ago, associated with stress related to family and in-law dynamics. Her symptoms have decreased in frequency as the stressful situation has resolved. She has no significant history of cardiovascular or pulmonary disease and reports a generally healthy lifestyle with controlled GERD and celiac disease. The review of systems is largely unremarkable, aside from her reported palpitations, decreased appetite, and fatigue. Her case highlights the potential impact of stress and anxiety on physical health, particularly in the context of palpitations. Further evaluation and management should consider the role of stress and possible strategies for stress reduction, alongside monitoring for any underlying cardiac issues.