Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope...
Transcript of Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope...
![Page 1: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/1.jpg)
![Page 2: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/2.jpg)
Presenters:
Adan Pacheco, MD
Alexandro Atilano, MD
Cardiology/Internal Medicine
Hospital Universitario UANL Mty, Mex.
Case Study
![Page 3: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/3.jpg)
Patient
• Gender: Male
• Age: 39
• Occupation: Production Supervisor
• Religion : Catholic
•Civil Status: Married
![Page 4: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/4.jpg)
• He presents with dyspnea and orthopnea over past seven days.
• Denies chest pain. Has had palpitations on and off for the past two weeks. No fever or cough. He has been taking all of his medications
History of the current illness
![Page 5: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/5.jpg)
• Allergies: No known drug allergies (NKDA).
• Tobacco history: Smoked 2 packs a month; quit when he was diagnosed with pre-diabetes.
• Alcohol history: Drinks 2 beer a week.
• Family history: Mother “tachyarrhythmia” carrier of a bicameral pacemaker; father deceased (age 70, colon cancer); 1 brother SVT
Background
![Page 6: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/6.jpg)
• Appendicectomy 20 years ago
•LBBB dx 7 years ago in a medical check-up no other
abnormalities
•Pre-syncope single episode 6 years ago
•Fasting glucose intolerance (prediabetes) and hyperlipidemia
managed according to guidelines dx 5 years ago
•Atrial flutter dx 5 years ago treated with elective cardioversion
(atrial thrombi discarded by TEE), converted to sinus rhythm.
•Last reported electrocardiogram (January 2017) 1st degree AV
block and LBBB.
Past medical history:
![Page 7: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/7.jpg)
•Aspirin 100mg qd
•Ezetimibe/Simvastatine 10/20mg qd
•Metformin XR 500mg qd
Medications:
![Page 8: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/8.jpg)
VitalsBP = 134/82 mm Hg
HR= 88 bpm at rest
irregularly irregular
pattern
BR= 13 bmp
SatO2: 95% RA
T°: 37.6°C
Height: 1.7 m
Weight: 80 kg
BMI: 27.68 Kg/m²
Physical exam
The remainder of his examination is completely normal with no
clinical evidence of right- or left-sided congestive heart failure.
![Page 9: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/9.jpg)
Lab’s
• Chem: Glu 102/Creat 0.9/BUN 18.
• Electrolytes normal.
• Urinalysis normal.
• CBC normal.
• LFT’s normal. INR 1.1
• TFT TSH 3.2 FT4 1.53
![Page 10: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/10.jpg)
![Page 11: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/11.jpg)
![Page 12: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/12.jpg)
Echocardiogram
•
![Page 13: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/13.jpg)
![Page 14: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/14.jpg)
![Page 15: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/15.jpg)
![Page 16: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/16.jpg)
![Page 17: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/17.jpg)
![Page 18: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/18.jpg)
![Page 19: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/19.jpg)
![Page 20: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/20.jpg)
![Page 21: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/21.jpg)
![Page 22: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/22.jpg)
![Page 23: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/23.jpg)
Meds
• Spirinolactone 25 mg qd
• Rivaroxaban 20 mg bid
• Amiodarone 200 mg bid
• Ramipril 2.5 mg qd
Management
![Page 24: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/24.jpg)
Procedure:
• Cardiac resynchronization therapy with implantable defibrillator
• VIVA XT CRT-D
• Parameters:
• With a defibrillation basal algorithm and echocardiographic resynchronization guidance.
Management
![Page 25: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/25.jpg)
![Page 26: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/26.jpg)
![Page 27: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/27.jpg)
![Page 28: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/28.jpg)
![Page 29: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/29.jpg)
![Page 30: Presentación de PowerPoint/media/Non-Clinical/Files-PDFs-Excel-MS-Word … · •Pre-syncope single episode 6 years ago •Fasting glucose intolerance (prediabetes) and hyperlipidemia](https://reader033.fdocuments.us/reader033/viewer/2022060519/604cb23f0011782a407aad26/html5/thumbnails/30.jpg)