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Case 3
Clinician: Alan Gradman, MD
A 71-year-old Caucasian man with a 12-year history of HTN. In addition, he suffered an MI 18 months ago. He now reports recurrent chest pain occurring with moderate-to-strenuous exertion.
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Background
- 71-year-old Caucasian man complains of exertional chest pain of 3 weeks duration
- Medical history
- 12-year history of HTN
- MI 18 months ago
- Hypercholesterolemia
- Social history
- 40-year history of cigarette smoking
- Stopped following MI
Physical Examination
- Height, 5'10"; weight, 177 lb
- BP, 148/84 (on medication); P, 68 bpm
- BMI, 25.4 kg/m2; waist circumference, 34"
- Physical, (+)soft systolic murmur on lower left sternal border, no rales, and jugular venous distension or peripheral edema; the remainder of the examination is normal
Laboratory results
- Na+, 138; K+, 3.9; BUN, 18; Cr, 1.2; uric acid, 6.3;
estimated Cr clearance, 68 mL/min; and urine protein, 280 mg/g Cr
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