Cardiovascular System


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M31_F1.jpg"}},{"insert":"\n\n\u0027Here we go, doctor!\u0027 Your friendly receptionist opens the door and lets in your first patient of the day, Mike, into your office.\n\nLooking through his medical records, you note that Mike is 52 years old, and that he suffers from diabetes, hypertension and obesity. He is currently on ramipril, metformin and linagliptin. Mike is an ex-smoker who stopped at age 35. He has a family history of ischemic heart disease, with his father passing away from a myocardial infarction at the age of 60. At his last clinic review, you arranged for a fasting lipid profile.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M31_F3.jpg"}},{"insert":"\n\nMike is here today with his wife, Caroline, and their son. You greet the family and invite them to sit down. \n\n\u0022Hi, Mike! How\u0027ve you been?\u0022\n\n\u0022Great!\u0022 comes his response. \u0022I\u0027ve been regular with my medication and I\u0027ve been controlling my diet. I\u0027m also on a regular exercise routine and haven\u0027t had a drink in a couple of months.\u0022\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M31_F4.jpg"}},{"insert":"\n\nYou express appreciation for his progress, aware that sticking to treatment and diet regimens is far easier said than done. \n\n\u0022Thanks, doctor, it hasn\u0027t been easy!\u0022 he responds, sounding pleased.\n"}]}


{"ops":[{"insert":{"image":"\/storage\/case-images\/cs\/M31_F5.jpg"}},{"insert":"\n\nAs you review the results of Mike\u0027s lipid profile, your jocularity quickly subsides. His triglycerides are 160 mg\/dL, HDL is 40 mg\/dL, LDL is 125 mg\/dL and total cholesterol is 290 mg\/dL. You realize that he has dyslipidemia; and that he fulfils the criteria for the metabolic syndrome.\n\nYou proceed to explain the diagnosis to Mike, and re-emphasize the importance of lifestyle measures such as diet and exercise. However, given his high cardiac risk profile, this will not be sufficient. You explain that you would like to start him on medications. \n"}]}