Reference no: EM133505133
Assignment:
A 63-year-old man is referred to your clinic for evaluation of chest pain. He reports several weeks of exertional chest tightness associated with mild shortness of breath when he is mowing the lawn. These symptoms never occur at rest.
Pt has a history of type 2 diabetes and hypertension, has no significant family history. He admits to smoking a pack of cigarettes a day but has quit smoking twenty-five years prior.
His medications include metformin 1000 mg twice daily, lisinopril 10 mg daily, aspirin 81 mg daily, and hydrochlorothiazide 25 mg daily.
His blood pressure is 139/87 mm Hg with a pulse of 75 beats per minute (bpm) and a body mass index (BMI) of 31. His exam is notable for slightly diminished dorsalis pedis and posterior tibial pulses with normal lower extremity perfusion and no edema. Assessment was otherwise unremarkable.
His laboratory values are significant for HbA1c 8.4%, total cholesterol 227 mg/dL, high-density lipoprotein cholesterol (HDL-C) 37 mg/dL, triglycerides 255 mg/dL, low-density lipoprotein cholesterol (LDL-C) 142 mg/dL, TSH of 1.3 mIU/L and serum creatinine of 1.1 mg/dL.
1. Discuss in detail the head-to-toe assessment you would provide for this patient and why it pertains to your patient.
2. Based on this information, describe in detail how smoking can affect perfusion.