Hypertension (primary, no discernible cause) and hyperlipidemia (LDL cholesterol especially) damage the arterial endothelium and lead to atherosclerosis.
Atherosclerosis is a systemic disease of the major arterial systems: cerebral, coronary, and peripheral.
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Atherosclerosis narrows the artery, in this case the coronary artery, and decreases myocardial oxygen supply. This is complicated by anemia, which further decreases oxygen supply.
Pharmacotherapy is directed at controlling hypertension (HCTZ and CCB), treating hypercholesterolemia (atorvastatin), and preventing a first cardiac atherosclerotic event (aspirin)
Case Presentation
Reason for the encounter: The patient is a 52-year-old peri-menopausal person who is at a primary care clinic for a routine annual exam.
Vital signs: Interpret these
- 98.6-86-16-168/94 (RA) -99% (current visit); BMI: 32
- 97.6-80-20-150/92 (RA) – 99% (one year ago); BMI: 30
- 98.4-76-18-156/82 (RA) – 99% (two years ago); BMI: 28
History:
- Medical: Irregular menses
- Surgical: NA
- Social: Lives with spouse, two teenage children; does not smoke, drinks occasionally.
- Family: Mother deceased, COD stroke; father deceased, COD heart attack; sister alive, renal insufficiency.
Labs: Place arrows up/down for values that are outside the range of normal and interpret the results.
| BMP | CBC | ||
| Na | 142 mOsm/L | WBC | 9.8 |
| K | 3.9 mOsm/L | RBC | 2.9 |
| Cl | 105 | Hemoglobin | 9 |
| CO2 | 24 | Hematocrit | 27 |
| BUN | 15 | MCV | 68 |
| Creatinine | 1.2 | MCHC | 25 |
| eGFR | 53 mLs/minute | Platelet | 220 |
| FBS | 136 |