What other patient risk factors put the patient at risk for arteriosclerotic coronary vascular disease (ASCVD)?

Discussion Part One (graded)

B.J., a 70-year-old black female has been seen in the clinic several times. The last time she was in for a check-up was 6 months ago to get her prescriptions refilled. She has returned to the clinic today because she “ran out of blood pressure medicine” and would like to get her prescriptions renewed. She has not taken any prescription medicine in approximately 6 months

Background:

The patient indicates that she has noticed shortness of breath, especially when she is playing with her grandchildren. But, it goes away once she sits down to rest. She reports that she is also bothered by shortness of breath that wakes her up at night, but it resolves after sitting upright on 3 pillows.  She also tells you that “I noticed over the last week that my legs and ankles have been swollen”. She also indicates that she often feels light headed and faint while going up the stairs, but it subsides after sitting down to rest.

PMH:

Hypertension

Previous history of MI in 2010

Current medications:

Coreg 6.25 mg PO BID

Colace 100 mg PO BID

K-dur 20 mEq PO QD

Furosemide 40 mg PO QD

Surgeries:

2010-Left Anterior Descending (LAD) cardiac stent placement

Allergies: Amoxicillin

Vaccination History:

She receives an annual flu shot. Last flu shot was this year

Has never had a Pneumovax

Has not had a Td in over 20 years

Has not had the herpes zoster vaccine

Other:

Last colorectal screening was 11 years ago

Last mammogram was 5 years ago

Has never had a DEXA/Bone Density Test

Last dilated eye exam was 4 years ago

Labs from last year’s visit: Hgb 12.2, Hct 37%,  K+ 4.2,

Na+140 Cholesterol 186, Triglycerides 188, HDL 37, LDL 190, TSH 3.7

Blood pressure on day of visit: 150/90

Social history:

She graduated from high school, and thought about college, but got married right away and then had kids a short time later. Her son lives in another state,

Family history:

Both parents are deceased. Father died of a heart attack; mother died of natural causes.  She had one brother who died of a heart attack 20 years ago at the age of 52.

Habits:

She drinks one 4-ounce glass of red wine daily. She is a former smoker that stopped 20 years ago.

Discussion Part One:

• Summarize the important data from the patient’s history and reason for the visit today.
• Provide differential diagnoses (DD) with rationale.
• Further ROS questions needed to develop DD.
• Based on the LDL level above, indicate if you need to order a statin for this patient? Provide a rationale for your decision based on evidence based clinical guidelines.
• What other patient risk factors put the patient at risk for arteriosclerotic coronary vascular disease (ASCVD)?
• Based on the patient data provided, choose geriatric assessment tools that would be appropriate to use in conducting a thorough geriatric assessment. Provide a rationale on why you are choosing these particular tools.