Skill Checkup: A 43-Year-Old Man With a History of Smoking and Current Pressure in the Middle of the Chest and Dyspnea

Romesh Khardori, MD, PhD, FACP


January 12, 2022

The Skill Checkup series provides a quick, case-style interactive quiz highlighting key guidelines- and evidence-based information to inform clinical practice.

A 43-year-old man presents with pressure in the middle of the chest and dyspnea. He is 5 feet 10 inches and weighs 166.5 lb (BMI, 23.9). The patient reports a history of smoking of less than 10 years, noting that he quit after college, and explains that his father has cardiovascular disease (CVD). Palpation detects a diffusely thickened Achilles tendon. Although the patient is currently taking lipid-lowering medication, laboratory analysis is remarkable for low-density lipoprotein cholesterol (LDL‐C) level of 294 mg/dL.


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