CASE STUDY WORKSHOP 2

CASE STUDY WORKSHOP 2

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This is a follow-up visit….

This is a 66-years-old male; with PMH of CAD diagnosed patient with stent inserted in 2010; carotid artery disease with stent 1999; aortic stenosis; CVA 1998. Additionally, he is DM Type 2 and had a colon cancer condition with resection in 2011. Mr. M.L is a Retired Veteran, who lives with wife and 2 dogs. The wife has MS, and he is the caregiver for her. Rarely drinks ETOH; smokes since teenage years.

The day of his visit the V/S were BP 165/98 mmHg; Height: 5’10”; weight 208 lbs; BMI 29.8 kg/m2; HR 64/min; RR 23 per minute; Temperature 97.5 °F. Patient takes usual secondary prevention medications: ASA 81 mg; Simvastatin 40 mg; Clopidogrel 75 mg; Losartan HCTZ 50-12.5 mg; Metoprolol XL 25 mg; Amlodipine 5 mg; Metformin 1,000 mg; Omeprazole; Prilosec OTC The last laboratory test: Lipid panel: TC 156, TG 209, HDL 47, LDL 67 mg/dL; Hemoglobin A1C 6.3% . Reports eating “only organic” foods; walks dogs twice a day; swims in backyard pool during the summer and expresses that he is NOT interested in quitting smoking. When addressing the effects of secondhand smoke on his wife, he responded, “Then she shouldn’t have married me!”

The patient reports that he is fatigued since this Chicago winter. He uses a snow blower however he also uses a shovel. Lately when its subzero, he feels shorter of breath walking his dogs. He has felt some indigestion when shoveling snow. He started to double Prilosec OTC however the indigestion goes away in several minutes after he stops shoveling snow. He isn’t sure if he has arm pain as well because his left arm gets sore from shoveling snow. Denies palpitations, lightheadedness, syncope, and claudication. On physical examination, patient looks fine. Lungs clear, but he become with SOB after a short activity. Continues with pain in Left Arm that irradiates to the jaw and the thorax. Mr. M.L. states he feel fainting, but states that the shoveling duties are the reason of that feeling.