Question

A 30-year-old man with chest pain was brought to the emergency department after a softball game. He was placed in the coronary care unit when his ECG showed erratic waves in the ST region. A family history revealed that his father died of a heart attack at the age of 45 years.

ADMISSION LABORATORY RESULTS BMP LIPID PANEL

Sodium 139 135–143 mEq/L

Cholesterol 278 mg/dL

Potassium 4.1 3.0–5.0 mEq/L

Triglyceride 170 mg/dL

Chloride 101 98–103 mEq/L

HDL 47 mg/dL

CO2 29 22–27 mmol/L

Calculated LDL 163 mg/dL

Glucose 98 75 – 105 mg/dL

BUN 15 7 – 25 mg/dL

Creatinine 0.9 0.5 – 1.2 mg/dL

Refer to the NCEP ATP III guidelines to answer the following questions.

1. What category is he now in? Why?

2. What was done correctly on admission?

3. What will be his LDL treatment goal?

Answer 1

Answer 1 Establish LDL goal of therapy

- Determine need for therapeutic lifestyle changes (TLC)

-Determine level for drug consideration

Answer 2  Determination of lipoprotein levels and obtain complete lipoprotein profile after 30-year-old man with chest pain was brought to the emergency department after a softball game was done correctly on admission

Answer 3 Primary aim of therapy is to reach LDL goal

-Intensify weight management

-Increase physical activity

-If triglycerides are >200 mg/dL after LDL goal is reached, set secondary goal for non-HDL cholesterol (total – HDL) 30 mg/dL higher than LDL goal.