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Comprehensive Case Presentation of a 61-Year-Old Female with Diabetes and Chronic Angina

This case presentation details the medical history and current condition of Maria Febi Billones, a 61-year-old female with a significant history of diabetes and hypertension. Initially presenting with dyspnea and symptoms indicative of chronic stable angina, Maria experienced progressive fatigue and reported concerning episodes over the past year. The case highlights the assessment findings, including an ECG and chest X-ray, along with recommendations for further diagnostic work and therapeutic dilemmas related to diabetes management and cardiovascular health.

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Comprehensive Case Presentation of a 61-Year-Old Female with Diabetes and Chronic Angina

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Presentation Transcript

  1. Case Presentation Maria Febi C. Billones January 13, 2010

  2. General Data • R.Q. • 61 y/o • Female • Married • Bicutan

  3. Chief Complaint • Dyspnea

  4. Patient Profile • Known diabetic x 15 years • Initially presented with 3 P’s & weight loss • Prescribed with Glibenclamide 5mg BID however with poor compliance

  5. Patient Profile • Known hypertensive x 5 years • HBP 150/100 • UBP 120/90 • No medications taken

  6. History of Present Illness • 1 year PTC  patient noticed easy fatigability usually after simple household chores associated with dyspnea on exertion • She also experienced occasional chest heaviness lasting almost the whole day aggravated by work and relieved temporarily by rest

  7. History of Present Illness • 3 months PTC  noted worsening of symptoms hence had herself an ECG and Chest Xray in a nearby laboratory clinic • However, results revealed “within normal limits” on ECG and “Atheromatous Aorta” on Xray hence decided not to seek medical consult

  8. History of Present Illness • Persistence of dyspnea as well as easy fatigability prompted consult. • (-) cough, colds, orthopnea, PND, edema • (-)

  9. Review of Systems • (+) polyuria • (+) polydipsia • (+) nocturia • (-) oliguria • (-) paresthesias • (-) fever • (-) weight loss • (-) dizziness • (+) headache, occasional • (+) nape pains, occasional • (-) blurring of vision • (-) nausea • (-) vomiting • (-) abdominal pain • (-) diarrhea • (-) constipation

  10. Past Medical History • s/p Total Hysterectomy for multiple myoma, 1978 at UDMC • s/p breast cyst excision, 1972 • (-) asthma, allergy, PTB

  11. Family Medical History Diabetes PTB Hypertension Schizophrenia Brain Tumor

  12. Personal Social History • previous smoker 1-2 sticks/day x 1 yr (1978) • occasional alcoholic beverage drinker • College Graduate, previously worked in a bank • Eventually lost her job and currently on financial crisis

  13. OB-GYN History • Nulligravid • Underwent total hysterectomy for multiple myomas at 28 y/o • Menarche at 16 y/o, monthly regular interval, 5 days duration, moderate amount, (-) dysmenorrhea

  14. PHYSICAL EXAMINATION

  15. Physical Examination • General Survey • Conscious, coherent, not in respiratory distress • Vital Signs • BP 150/90 • HR 58 • RR 22 • Temp 37.1 • Wt 70.3kg Ht 161cm BMI 27

  16. Physical Examination • HEENT • pink conjunctivae, anicteric sclerae, no nasoaural discharge, no tonsillopharyngeal congestion • Neck • No anterior neck mass, no cervical lymphadenopathy, no neck vein engorgement

  17. Physical Examination • Chest/Lungs • Equal chest expansion, no retractions, clear breath sounds • Heart • Adynamic precordium, bradycardic, regular rhythm, distinct heart sounds, apex beat at 5th ICS LMCL, no murmur • Abdomen • Flabby, (+) incision scar, infraumbilical area, normoactive bowel sounds, soft, non-tender

  18. Physical Examination • Extremities • Full and equal pulses, pink nailbeds, no edema, no cyanosis, no jaundice • Neuro Exam • Awake, alert, follows commands, oriented • Cranial Nerves • 1 – N/A; 2 – pupils 3mm EBRTL; 3,4,6 – full & equal EOMs; 5 – brisk corneals; 7 – no facial asymmetry; 8 – intact gross hearing; 9,10 – good gag, 11 – good shoulder shrug, 12 – tongue midline

  19. Physical Examination • Neuro Exam • MMT – 5/5 all extremities • Sensory – 100% intact • DTRs - ++ • Cerebellars: no dysmetria • Meningeals: supple neck, no incontinence

  20. Assessment t/c Chronic Stable Angina Pectoris DM Type 2, non-insulin requiring, Obese I t/c DM nephropathy Hypertension Stage 1, uncontrolled

  21. Plan • Diagnostic • FBS, BUN, Crea, Na, K, Cl, Ca, Mg • Urinalysis • 12-L ECG • Therapeutics • Metformin 500mg BID • Losartan 50mg OD

  22. Plan • Lifestyle Modification • Low salt low fat diet, low protein high fiber diet • Daily BP monitoring, sugar monitoring • Refer to Ophtha

  23. Diagnostic Dillemma • Among diabetic patients, what is the sensitivity and specificity of 24 hr urine albumin vs urine micral test in early detection of DM nephropathy?

  24. Diagnostic Dillemma • P – patients with diabetes • I –24 hr urine albumin vs urine micral test • O – in early detection of DM nephropathy • M – cross sectional studies

  25. Therapeutic Dillemma • Among long term diabetic patients, which is more effective between ACE-inhibitor and Angiotensin-receptor blocker in delaying the progression of diabetic nephropathy?

  26. Therapeutic Dillemma • P – patients with long term diabetes (>10yrs) • I – ACE inhibitor vs ARB • O – in delaying the progression of diabetic nephropathy • M – randomized control trial

  27. Thank you...

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