Skill Checkup: A 71-Year-Old Man With History of Type 2 Diabetes and Related Hypertension Experiences Retrosternal Pressure

Carolyn Newberry, MD, PNS


December 21, 2022

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

A 71-year-old Hispanic man in the United States presents with complaints of experiencing a retrosternal pressure ("squeezing") while cleaning out the basement and carrying boxes. He immediately sat down, and the feeling abated after about 5 minutes. The patient has a 10-year history of type 2 diabetes (T2D) and related hypertension. He engages in regular light exercise walking the dog about 1 mile a day. He has never smoked. His daily diet includes two to three cups of coffee each morning. Over the past 10 years, the patient's hemoglobin A1C has remained > 8.0%. He has gradually gained weight over several years. His medications have not been changed since T2D diagnosis, except to increase metformin dosage from 750 mg/day to the current 1000 mg/day. His other current medications are hydrochlorothiazide 50 mg/day and amlodipine 10 mg/day for hypertension. At his last visit 3 months ago, A1C was 8.7%, blood pressure was 145/90 mm Hg, and body mass index (BMI) was 30.1 kg/m2 (he is 5'10" or 1.78 m and weighs 210 lb or 95.35 kg). He has no lower extremity edema or jugular vein distension.


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