Question

Cardiovascular Case Study

A 47-year-old male patient, who is a house painter and whom you haven't seen in several years, presents

with chronic fatigue and mild chest pain frequently relieved by taking a break from painting. He's

married to a 47-year-old woman with multiple sclerosis and has two married children and one

grandchild living nearby. He also complains of frequent eructation, flatulence, and indigestion after

eating. He was told (when he weighed 30 lbs. less than he does now) that he could control his

hyperlipidemia by diet.

CC: "I'm always tired, and I have this annoying chest pain when I climb a ladder."

Past medical history: Anxiety, cholecystectomy, vasectomy

Vital signs: Blood pressure (BP): 146/88; height, 6 ft; weight, 242 lbs.

Lab results: TC 230; LDL 180; HDL 32

• What additional subjective data do you think the patient will share?
• What additional objective data will you be assessing for?
• What National Guidelines are appropriate to consider?
• What tests will you order?
• Will you be looking for a consult?
• What are the top 3 differential diagnoses and why? What is your final diagnosis? Give rationale.
• Are there any legal/ethical considerations?
• What is your plan of care?
• Are there any Healthy People 2020 objectives that you should consider?

Answer 1

Subjective data:-The patient will also complain of lying flat and sleep.

Objective data:- What kind of paint you work with? Do you have palpitation.

National guidelines to consider is NYHA classification

(New York heart association -functional classification)

Tests : ECG, Echo, S. Ferritin, S. Sodium & potassium, S Urea and Creatinine, chest x ray, Haemoglobin, Differential count, peripheral smear(leucopenia),CK MB

Consultation:Gastroenterology and cardiology

Differential diagnosis:- 1 Fibrosis of lung as he is having chest pain as well as exertional dyspnoea

2.Congestive cardiac failure( iron deficiency anaemia) mild chest pain relieving on rest

3.mercury poisoning because of his occupation

Best diagnosis Congestive cardiac failure/Systemic hypertension/leucopenia/dyslipidemia

Plan of treatment : Take a break from current work, Start on anti hypertensive:

Cardioprotective drugs : Beta blockers ( metoprolol), digoxin,

Reduce dyspnoea: frusemide

Cholesterol lowering drug: Atorvastatin

Objective 2020: Avoid further exposure to Mercury paint,

Find an alternative job where less exertion is needed.