New diagnosis of diabetes following myocardial infarction
Marco is a 56-year-old man who developed atypical anginal symptoms at his worksite. He was taken to the ED and informed that he was having a myocardial infarction (MI). In the catheterization lab, Marco was treated with a single drug-eluting stent of the LAD. During his hospitalization, his blood glucose concentrations ranged from 135 to 240 mg/dL, and his A1c came back at 8.4%. He was discharged two days later with a number of new medications and a prescription for cardiac rehab. He was surprised to find out that he had type 2 diabetes (T2DM).
Marco has been resting at home for a month and is eager to return to work for financial reasons. He was discharged on lisinopril 20 mg daily, metoprolol titrate 100 mg bid, atorvastatin 40 mg daily, and ASA 81 mg daily. He reports that he has had palpitations and some episodes of shortness of breath during the past month.
Past Medical History: Prediabetes 2016, mixed hyperlipidemia 2012, high blood pressure 2012, obesity.
Family History: Mother with T2DM, brother a smoker with cardiovascular heart disease (CHD) age 53.
Medications: Was prescribed atorvastatin in 2016, but he reported he got muscle aches and discontinued taking. He had not started any of the new discharge meds yet as he wanted to check with you first.
Social History: Works in construction, is married and has three children. He is worried about the lost work since his diagnosis.
No tobacco, one to two beers per week, usually on Fridays. He does not read food labels or pay attention to what he eats, leaving those meal decisions up to his wife. He does not consume many fruits, vegetables, whole grains or fish. The family usually has beef for dinner, chicken once in a while, and occasionally fish. He has no regular activity or exercise program because he is too tired after working all day at the job site.
Exam: BMI 34 kg/m2, 5 ft. 6 inches,
210 lbs., BP 142/88, P 84, R 16
General: Obese, acanthosis on neck, truncal obesity
CV: HR occasionally irregular but no murmurs, PMI not widened, peripheral pulses normal
Resp: CTA A and P
Ext: Trace LE edema
eGFR 140ml /min
HbA1c = 8.4%
Lipids: total cholesterol 246, HDL-C 24, TG 220, LDL-C 178 mg/dL