Clinical learning points and practical applications

Clinical Learning Points

Clinical Case Study Key Learning Points

Given the patient's history with angina and cardiac conditions, there is a clear need to ensure that he does not allow bad habits to continue in addition to the careful management and monitoring of his health. The patient's medical history also includes known diagnoses for diabetes, hypertension, and obesity. His father had also passed from heart disease, indicating a genetic predisposition to cardiac problems. The patient recently was discharged just a few days prior for a stent placement. He returned for an evaluation, claiming that his major cardiac symptoms, including crushing chest pain, shortness of breath and diaphoretic had subsided dramatically. Still, there is thought to be a high risk of future complications in regards to his cardiac health because of the fact that he has a very minimal support system in order to help him change his dietary and lifestyle habits. His wife is disabled and together the two of them are isolated from other support resources. Additionally, financial issues have been increasing the stress the patient has been experiencing, which is another indicator of potential complications in the future. However, the patient has admitted that he knows his lifestyle choices are affecting his health in a negative way, especially his over eating and excessive sleeping. He has voiced concern over potential cardiac problems in the future, which is a hopeful sign that he may begin to respond positively to interventions and suggestions for lifestyle changes, although he is clearly hesitant to do so.

The presenting diagnosis for this particular case highlighted some of the major health concerns impacting his health currently. The following tests were performed: BNP-to assist in ruling out CHF, Echocardiogram to determine heart function, Carotid ultrasound, and Lower extremity venous Doppler, and Urine Analysis. During lab testing, results discovered the presence of Carotid bruit, which is indicative of cartoid stenosis. Also, additional lab tests from this current evaluation and before he was admitted for the placement of the stent showed signs that would suggest a diagnosis of android obesity, as he had high levels of cholesteral, including an LDL level of 200. Previous lab testing from earlier visits shows a diagnosis of Type 2 diabetes. Triglycerides were also high, at 250. Ultimately, this resulted in a diagnosis of hypercholesterolemia. Because of these diagnoses, the patient is currently on Atenolol (Tenormin XL) -- 50mg QD, Atorvastatin (Lipitor) -- 10mg QD, Metformin (Glucophage) -- 50mg BID, and Acetylsalicylic Acid (ASA) -- 81mg QD.