Clinical Case 2-1
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ScribdTranslationsClinical Case 2-1
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ScribdTranslationsCardiovascular risk factors. Regarding a clinical case.
Miriam Carbó Díez.
61-year-old male patient, ex-smoker of 20 cigarettes a day since 2008, without habit.
no known drug allergies, enters the Internal Medicine ward
for a laborious effort.
As a medical history, the patient is affected by Diabetes Mellitus.
type 2 since 2008, currently being treated with sitagliptin, metformin, and gliclazide
(Glycosylated HbA1 8.3%) with good control of preprandial basal glycemia as reported.
absence of known retinopathy or nephropathy; he is hypertensive on treatment with ACE inhibitors
and dyslipidemic on statin treatment. The patient has been following up since
2012 for vascular surgery since he presents symptoms of intermittent claudication at the
500m.
The patient's usual treatment is recorded as follows: Metformin 850
mg, 1-1-1; Sitagliptina 100 mg, 1-0-0; Gliclazida 30 mg, 4-0-0; Simvastatina 40 mg, 0-
0-1; Omeprazol 20 mg, 1-0-0; Enalapril 5 mg, 1-0-0.
The current illness is determined because during the previous month, the patient has
presented, with increasing frequency and a threshold of progressively lesser effort,
recurrent episodes of oppressive central chest pain radiating to the limb
superior left triggered by effort, without vegetative manifestations,
which subsided with rest. On the morning of 04.05.13, she experienced three episodes of
equal characteristics triggered by small efforts so he decides
consult
In the emergency service, there was a tendency towards hypertension (BP 150/95mmHg),
FC 75 beats per minute, absence of respiratory effort, and capillary blood glucose of 276 mg/dL as well as
truncal obesity (BMI 32.7). Physical examination showed tones
rhythmic heart sounds without murmurs, and absence of right pedal and popliteal pulses. No
showed signs of heart failure.
An ECG was performed that showed sinus rhythm and signs of subepicardial ischemia.
anteroseptal; the curve of myocardial injury markers was negative. In the
chest X-ray showed an increase in the cardio-thoracic index and absence of
signs of vascular redistribution.
With the diagnostic orientation of exercise angina, treatment began with dual
antiaggregation (AAS and clopidogrel), anticoagulation with enoxaparin, nitrates
transdermal and treatment with bisoprolol was started, keeping ACE inhibitor unchanged.
On 11.03.14, a coronary angiography was performed where 80% stenosis was observed in the
proximal anterior descending (DA), on which angioplasty was performed and
implanted a stent, an 85% lesion in the distal third of the same artery, without
significant lesions in the circumflex (Cx) and right coronary (CD).
The echocardiogram showed a slightly dilated left ventricle, not
hypertrophied, with good global contractility (EF: 61%), apical septal akinesia,
diastolic dysfunction, without dilation of the left atrium and mild mitral insufficiency.
In the income analysis, an HbA1 of 8.6% and a total cholesterol of 284 were determined.
mg/dL (c-LDL 180mg/dL, c-HDL 50mg/dL), uric acid of 456 µmol/L, renal function,
hepatic and normal ions.
During his hospital admission, he did not have new angina episodes, remaining in
at all times hemodynamically and clinically stable. An ABI (ankle-brachial index) was performed.
arm).
To highlight during the first 48 hours of admission, poor control of diabetes, with
capillary preprandial glycemia in most cases is above 230mg/dL despite
has maintained its medication with usual (gliclazide, metformin, and sitagliptin),
requiring basal insulin and fast insulin regulation for its control. Finally
and according to the patient, treatment with nocturnal NPH insulin 14UI was started and
only maintained dosage with metformin 850mg every 12 hours, with a good
control at the high.
On the other hand, the patient was educated with a heart-protective diet, and resources were provided.
cardiovascular health exercise guidelines.