You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M., a man who has been coming to the clinic for several years for management of coronary artery disease (CAD) and hypertension (HTN).
A cardiac catheterization done a year ago showed 50
stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and
orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months.
On his last clinic visit 3 weeks ago, a chest x-ray (CXR) examination revealed cardiomegaly, and a 12-lead
electrocardiogram (ECG) showed sinus tachycardia with left bundle branch block (LBBB). You review J.M.'s
morning blood work and initial assessment.
Laboratory Results
Chemistry
Sodium 142 mEq/L
Chloride 95 mEq/L
Potassium 3.9 mEq/L
Creatinine 0.8 mg/dL
Glucose 82 mg/dL
BUN 19 mg/dL
Complete Blood Count
WBC 5400/mm3
Hgb 11.5 g/dL
Hct 37
Platelets 229,000/mm3
Initial Assessment
Complains of increased fatigue and shortness of breath, especially with activity, and waking up
gasping for breath at night, for the past 2 days.
Vital Signs
Temperature 97.9 F (36.6 C)
Blood pressure (BP) 142/83 mm Hg
Heart rate 105 beats//min
Respiratory rate 18 breaths/min
As you review these results, which ones are of possible concern, and why?
Question 2
After taking the second NTG SL tablet, B.T. complains of a terrible headache and worries that he is getting worse.
What is happening, and what should you tell him?
Aneurysm. Photograph of the aorta, the large blood vessel arising from the heart, with a large bulge
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