From the Guidelines
The patient's phentermine has been discontinued due to the detection of a new heart murmur, reported palpitations, and a significant family history of cardiac disease, and a referral to cardiology has been placed to evaluate the heart condition and determine the safety of restarting phentermine. The patient is a 55-year-old female who presents for follow-up after a new heart murmur was detected during her previous visit by another provider. She was taking phentermine for weight management, which has now been stopped due to cardiac concerns, as recommended by the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1. Today, she reports experiencing palpitations which she attributes to rosuvastatin therapy. She also discloses a significant family history of cardiac disease.
Key Points to Consider
- The detection of a new heart murmur warrants further evaluation to determine its cause and significance, as most systolic heart murmurs do not signify cardiac disease, but some may be an important clue to the presence of valvular, congenital, or other structural abnormalities of the heart 1.
- The patient's reported palpitations with rosuvastatin, though an uncommon side effect, warrant further investigation in the context of her cardiac findings and family history.
- Phentermine is a sympathomimetic amine that can increase heart rate and blood pressure, potentially exacerbating underlying cardiac conditions, and should be avoided in patients with a history of cardiovascular disease, as recommended by the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1.
Next Steps
- The cardiology evaluation will help determine the nature of the heart murmur and assess cardiac function before considering whether phentermine can be safely restarted.
- The patient's blood pressure and heart rate should be monitored periodically, as recommended by the AGA clinical practice guideline on pharmacological interventions for adults with obesity 1.
- Further investigation into the patient's palpitations and cardiac findings is necessary to determine the best course of treatment and management.
From the Research
History of Present Illness (HPI)
- The patient is a 55-year-old female who presented with palpitations due to rosuvastatin.
- She has a family history of cardiac disease.
- During her last office visit, a new heart murmur was heard during evaluation.
- The patient was taking phentermine, which has been stopped, and a referral to cardiology has been placed.
- The patient's symptoms and medical history suggest a potential cardiac condition, which may be related to the use of phentermine 2 or other underlying cardiac issues 3, 4.
- The patient's family history of cardiac disease increases her risk for cardiac conditions, and the presence of a heart murmur requires further evaluation 5.
- The use of rosuvastatin may also be a contributing factor to the patient's palpitations, and its potential effects on cardiovascular outcomes should be considered 6.
- A thorough cardiac physical examination and further evaluation, such as echocardiography, may be necessary to determine the underlying cause of the patient's symptoms and murmur 5.