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A 52-Year-Old Woman With Hypertension and Diabetes Who Presents With Chest Pain

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	PRESENTATION

 
L.R. is a 52-year-old Caucasian woman with a known history of prehypertension, dyslipidemia, and type 2 diabetes. She presented to the office 6 months ago to get established. She had no complaints at that time. Her review of systems was negative except for some occasional fatigue. She smoked cigarettes as a teenager and young adult but quit 25 years ago. Her family history was positive for hypertension, type 2 diabetes, and myocardial infarction (MI) (father at age 62 and mother at age 68).

Her examination revealed a healthy appearing woman with height of 5'4'' and weight of 168 lb (BMI of 28.8 kg/m²). Her blood pressure was 138/88 mmHg. Initial laboratory evaluation revealed a random glucose of 180 mg/dl, triglycerides of 185 mg/dl, total cholesterol of 225 mg/dl, HDL cholesterol of 52 mg/dl, LDL cholesterol of 132 mg/dl, and hemoglobin A_1c (A1C) of 7.6%. She was on a sulfonylurea and metformin twice daily for her diabetes and atorvastatin daily for her dyslipidemia. She was instructed about starting a daily exercise program and agreed to a weight loss program.

She seemed to be doing well until she presented to the emergency room complaining of shortness of breathe and palpitations. On admission, she had elevated blood pressures in the range of 138-146 mmHg systolic and 86-90 mmHg diastolic. Her evaluation was negative, with normal electrocardiograms and cardiac enzymes. She was discharged the next morning on her same diabetes and cholesterol medications. A diuretic was added for her blood pressure. She was asked to follow up in the office in 1 week. At the 1-week follow-up visit, her examination revealed a weight of 175 lb (BMI 30.0 kg/m²) and blood pressure of 132/86 mmHg. She admitted to not exercising and not being serious about her weight loss program. Her 10-year coronary . . . [Full Text of this Article]

	QUESTIONS

 

	COMMENTARY

 

	CLINICAL PEARLS

 

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