Question

Part 1
DF is a 49-year-old African American man with a history of hypertension, diabetes, and dyslipidemia who presents to your clinic complaining of chest pain that occurred several
times over the past few weeks. DF describes his chest pain as “a heaviness.” He states that the discomfort first occurred while he was carrying groceries up to his third-floor apartment. Later, he experienced the same heavy sensation while raking leaves and again while carrying some boxes. The pain was located in the substernal area and radiated to his neck. The pain resolved after about 5 minutes of rest.

What information is suggestive of angina?
What tests would be beneficial in establishing a diagnosis?

Part 2
PMH
Hypertension, diagnosed 10 years ago; Diabetes, diagnosed 10 years ago; Dyslipidemia, diagnosed 8 years ago; Seasonal allergies, diagnosed ~25 years ago; Osteoarthritis
FH
Father with coronary artery disease, had a myocardial infarction at age 50 years; Two siblings each with coronary artery disease diagnosed in their 40s; Mother alive and well
SH
Quit smoking 5 years ago.; Denies alcohol or illicit drug use; No regular exercise program
meds
• Amlodipine 5 mg PO once daily; Metformin 500 mg PO twice daily; Pravastatin 20 mg PO at bedtime (has not taken in several months); Desloratadine/pseudoephedrine 2.5 mg/120 mg PO twice daily; Ibuprofen 400 mg twice daily as needed (uses most days)
Allergies: NKDA
PE
VS: Blood pressure = 164/90 mm Hg; Heart rate = 94 beats/min, respirations = 20
Temperature = 37°C (98.6°F); Height = 5’10” (178 cm), weight = 360 lb (163.6 kg)
cardiovascular: Regular rate and rhythm, normal S1 and S2, no S3 or S4; no murmurs, rubs, gallops
lungs: Clear to auscultation and percussion
abd: Nontender, nondistended, + bowel sounds
ext: 1+ lower extremity edema to the ankles bilaterally
labs
Fasting lipid profile: total cholesterol 196 mg/dL (5.07 mmol/L), HDL cholesterol 27 mg/dL (0.70 mmol/L), LDL cholesterol 127 mg/dL (3.28 mmol/L), triglycerides 211 mg/dL (2.38 mmol/L); fasting glucose 178 mg/dl (9.9 mmol/L); other labs within normal limits
exercise treadmill test: Positive for ischemia





Identify DF’s risk factors for ischemic heart disease.
What therapeutic alternatives are available to manage DF’s ischemic heart disease?​

Answer 1

Answer:

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