Subjective: Patient reports palpitations, described as a fluttering or skipping sensation in the chest.  Symptoms are intermittent and of variable duration.  No associated chest pain, shortness of breath, or dizziness reported at this time.  Patient denies syncope or near-syncope.  Review of systems otherwise negative.  Patient has a history of anxiety but denies increased stress recently.  Current medications include a daily multivitamin.  No known drug allergies.  Family history includes hypertension and hyperlipidemia.  Social history reveals occasional alcohol use and no tobacco use.

Objective:  Physical exam reveals a healthy-appearing individual in no acute distress.  Vital signs stable with blood pressure 12080 mmHg, heart rate 72 bpm and regular except for occasional skipped beats, respiratory rate 16, temperature 98.6F.  Cardiovascular exam reveals a regular rhythm with intermittent premature beats auscultated.  Lungs clear to auscultation bilaterally.  No peripheral edema.  Electrocardiogram (ECG) performed reveals normal sinus rhythm with frequent premature atrial complexes (PACs).  No ST-segment changes or other significant ECG findings.  Labs ordered include a complete blood count (CBC), comprehensive metabolic panel (CMP), and thyroid stimulating hormone (TSH) to evaluate for underlying causes.

Assessment:  Premature atrial contractions (PACs).  Differential diagnoses considered include sinus arrhythmia, atrial fibrillation, and supraventricular tachycardia.  Based on the patient's presentation, ECG findings, and lack of other significant symptoms, the diagnosis of PACs is most likely.  Further investigation with laboratory tests is warranted to rule out underlying metabolic or thyroid abnormalities.  ICD-10 code I49.1.

Plan:  Patient education provided regarding the benign nature of PACs in the absence of underlying heart disease.  Lifestyle modifications recommended, including reducing caffeine and alcohol intake, stress management techniques, and ensuring adequate sleep.  Follow-up scheduled in four weeks to review lab results and reassess symptoms.  If symptoms worsen or new symptoms develop, patient instructed to return sooner.  Will consider 24-hour Holter monitor if symptoms persist or become more frequent or concerning.  Discussed potential need for cardiology referral if indicated by further evaluation.