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?
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