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Cardiology
arrhythmias
premature ventricular complexes
A 52-year-old woman attends her annual routine health check-up at a general medical practice. She reports feeling generally well but occasionally notes a sensation of 'skipped beats,' though she denies any associated chest pain, dizziness, shortness of breath, or fatigue. Her medical history is unremarkable, with no chronic conditions, prior surgeries, or regular medications. She is a non-smoker and reports moderate caffeine and alcohol consumption. On physical examination, her blood pressure is 128/78 mmHg, pulse is 72 beats per minute and regular-irregular, and respiratory rate is 16 breaths per minute. Cardiac auscultation reveals an irregular rhythm with no murmurs or extra sounds. A 12-lead electrocardiogram (ECG) shows sinus rhythm with frequent, wide QRS complexes (duration 130 ms) identified as premature ventricular complexes (PVCs). Subsequent comprehensive evaluation, including 24-hour ambulatory cardiac monitoring, demonstrates monomorphic PVCs comprising less than 5% of total beats. Both an exercise treadmill test and a transthoracic echocardiogram reveal no evidence of structural heart disease or inducible ischemia. Considering these comprehensive diagnostic findings, what is the most appropriate long-term management strategy and prognostic counseling for this patient?
| Lab Parameter | Value | Reference Range |
|---|---|---|
| Sodium | 139 mmol/L | 135-145 mmol/L |
| Potassium | 4.1 mmol/L | 3.5-5.0 mmol/L |
| Magnesium | 0.85 mmol/L | 0.70-1.00 mmol/L |
| Hemoglobin | 138 g/L | 120-160 g/L |
| White Blood Cell Count | 7.2 x 10^9/L | 4.0-11.0 x 10^9/L |
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