When exercise isn’t good

Clinical scenario

A 51-year-old woman with a history of hypertension treated with candesartan presents with a recent history of shortness of breath on exertion and a sensation of her heart skipping beats.

She usually exercises several times a week, including swimming and yoga, though recently she has felt more tired. There has been no history of syncope. Physical exam is normal and a resting ECG is also normal. There are no other significant risk factors for coronary heart disease.