Skill Checkup: A 75-Year-Old Woman With Type 2 Diabetes Has Worsening Dyspnea and Significant Edema in Both Ankles

Jeffrey J. Hsu, MD


August 15, 2023

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

A 75-year-old White woman in the United States presents with worsening dyspnea and significant edema in both ankles. Her relevant history includes existing hypertension and type 2 diabetes (T2D), each diagnosed > 15 years ago, and weight issues, including obesity. She has never smoked. Her current medications, unchanged for the past 5 years, are lisinopril 10 mg/day for hypertension and once-weekly semaglutide 0.5 mg for T2D and weight control. Her last follow-up visit was 3 months ago. At today's visit, she is concerned about noticeable swelling in her ankles, stating this began about 2 months ago and occurs whenever she is sitting for more than an hour. She also reports increasing dyspnea with even mild exertion, including walking around her yard. She states that neither of these symptoms significantly impair her daily activities. At today's visit, her blood pressure is 128/85 mm Hg, body mass index is 28.1 kg/m2, hemoglobin A1c (HbA1c) is 7.3%, low-density lipoprotein cholesterol (LDL-C) is 110 mg/dL, and other lab tests are within normal range.


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