A 36-year-old female arrives at the clinic with reports of fatigue , palpitations , ringing in the ears , and Statem excessive tiredness with activity . The symptoms began with increased fatigue and have increased in severity Can gradually over the last 2 months . Palpitations occur sporadically but more often after a period of activity no other chest pain reported . Fatigue is relieved with periods of rest but is beginning to interfere with her ability to perform at work . Client denies any head injuries or adverse events occurring in the last 6 months
