Case StudiesQuiz of the month – April 2022
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Mortensen MB, Tybjærg-Hansen A, Nordestgaard BG
Journal: JAMA Cardiol
First published: July 6, 2022 DOI: 10.1001/jamacardio.2022.1876
Case Study: A 63-year-old male presents with central chest and vague left shoulder pain precipitated by a brisk walk up a steep hill. His pain resolved with rest. He is known to have three vessel coronary artery disease based on two previous cardiac catheterizations. He does more than 40 minutes of cardiovascular exercise at least four days a week, has no history of tobacco or drug use, and does not have diabetes.
Vital Parameters | Blood pressure: 110/65 mm Hg Resting heart rate: 65 Body mass index (BMI): 24 |
Medications | 40 mg of Atorvastatin, daily 81 mg of aspirin, daily |
Investigations | Lipid Profile: High-density lipoprotein (HDL) = 65 mg/dl Low-density lipoprotein (LDL) = 50 mg/dl |
The repeat cardiac catheterization reveals greater than 95% occlusion of his left main coronary, left circumflex, left anterior descending, and posterior descending arteries; and right main coronary artery has approximately 50% stenosis. Based on the diagnosis (high risk of CVD/CHD), he was treated with four-vessel coronary artery bypass grafting surgery, after which he returned to his functional baseline of vigorous exercise without angina. However, as The European Atherosclerosis Society consensus panel recommends, screening for anyone at an intermediate or high risk of CVD/CHD with an Lp(a) goal level of < 50 mg/dl, the cardiologist recommended measurement of Lp(a) which revealed an elevated Lp(a) level of 230 nmol/L, which is in the highest quartile.