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INTRODUCTION

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CASE LEARNING OBJECTIVES

  • Recognize the symptoms and diagnostic criteria of ischemic heart disease (IHD)

  • Identify risk factors for the development of IHD

  • Identify the treatment goals of IHD and appropriate lifestyle modifications and pharmacologic therapy to address each goal

  • Design an appropriate therapeutic regimen for the management of IHD based on patient-specific information

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PATIENT PRESENTATION

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Chief Complaint

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"I get pain in my chest and feel dizzy when I exercise. I have to stop exercising and rest for the pain and dizziness to go away."

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History of Present Illness

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GP is a 61-year-old African American male who presents to his primary care physician complaining of chest pain radiating to his neck and left shoulder, excessive sweating, and dizziness (over the last month) when he attempts to exercise on a treadmill or stair stepper. He describes the pain as "feeling tight" and "pressure-like." The symptoms resolve after resting for a couple of minutes. He denies dyspnea, nausea, or vomiting. He also denies symptoms at rest, with change in body position, or in relation to meals. GP is concerned that he will not be able to exercise, which he is doing to lose weight. He is hoping that he can take something to prevent the chest pain and other symptoms that occur with exercise. He also reports swelling in his ankles that is worse after being on his feet all day and relieved with leg elevation.

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Past Medical History

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HTN × 10 years

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Depression × 6 months

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Type 2 DM × 2 years

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Bursitis in left hip × 6 months after slipping on the ice

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Family History

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Mother died at age 45 from MI. Father is alive at age 78 S/P CABG at the age of 50. Son, aged 25, alive and well.

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Social History

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He is a widower as of 6 months ago. GP currently lives at home with his 24-year-old son and cat. He is employed as a chef.

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Tobacco/Alcohol/Substance Use

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(+) Tobacco; quit smoking 10 years ago, but restarted smoking about ½ ppd 6 months ago when his wife died. Denies illicit drug use; social drinker on the weekends.

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Allergies/Intolerances/Adverse

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Drug Events

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Penicillin (develops hives)

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Medications (Current)

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Fish oil 1,000 mg PO once daily

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Sertraline 50 mg PO once daily

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Lisinopril 40 mg PO once daily

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HCTZ 25 mg PO once daily

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Celecoxib 200 mg PO twice daily

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Glipizide XL 10 mg PO once daily

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Review of Systems

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