Skill Checkup: A 65-Year-Old Man With Established Type 2 Diabetes, Hypertension, Hyperlipidemia, and New-Onset Chest Pain

Romesh Khardori, MD, PhD


June 01, 2023

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

A 65-year-old Black man in the United States with a 5-year history of type 2 diabetes and a 7-year history of hypertension and hyperlipidemia presents today with reports of a "scary" episode of acute chest pain that occurred a few days ago. The pain appeared and intensified gradually as he was raking leaves until he had to stop; at that point, the pain lasted for about 5 minutes with rest. He describes the pain as "squeezing" or "heavy" and localized in the center of his chest. He worries that he has had a heart attack. This patient has no history of cardiac illness, has never smoked, and drinks fewer than three alcoholic beverages a week. He retired a few months ago and plays golf once a week, walking 18 holes.

The physical exam reveals an overweight but otherwise healthy-seeming person, with rales or abnormal heartbeat. His height is 5 ft 10 in and weight is 189 lb (body mass index of 27). His blood pressure is 129/85 mm Hg. Point-of-care A1c is 8.0%. Labs show low-density lipoprotein cholesterol (LDL-C) levels of 70 mg/dL and renal function within normal limits. Current medications are metformin 500 mg twice per day, telmisartan 20 mg once per day, and simvastatin 10 mg once per day at bedtime.


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