CASE STUDY 18 - Clyde Banks

Clyde Banks, a 57-year-old African-American man who works in New York City as a taxi driver, is admitted to the critical care unit with chest pain. He has smoked two packs of cigarettes per day for 25 years. He has high blood pressure and type 2 diabetes mellitus. His father died of a heart attack at 51 years of age. Other than bowling once each week, he leads a sedentary lifestyle. His typical food intake is high in fat and cholesterol.
Mr. Banks was bowling with friends when he felt pain in his chest. At first he ignored the pain, but it became a crushing sensation in his sternal area that spread down his left arm. The pain continued even after he sat down for a while. His friends became concerned and called an ambulance.
On admission to the hospital, his physical examination reveals a height of 5 feet 11 inches and a weight of 230 pounds. His blood pressure is 110/60. He has a pulse of 110 beats/min. His heart sounds irregular with an extra heart sound. He has crackling sounds at the bases of both lungs. His distal peripheral pulses are palpable but weak. His skin temperature is cool, and he is diaphoretic. The cardiac monitor shows irregular electrical activity. A 12-lead electrocardiogram indicates evidence of acute injury to the anterior myocardium. Cardiac enzymes are elevated in a pattern typical of myocardial infarction. High-density lipoprotein (HDL) levels are low, and low-density lipoprotein (LDL) levels are high.

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