CASE 92: A HEALTHY MAN?
History
A 50-year-old man has a health screen as part of an application for life insurance. He has
no symptoms. He smokes 15 cigarettes per day and drinks 10 units of alcohol per week. In
his family history his father died of a myocardial infarction aged 56 years.
Examination
He weighs 84 kg and is 1.6 m (5 ft 8 in) tall. His blood pressure is 164/98 mmHg.
Examination is otherwise normal.
Normal
Haemoglobin 15.2 g/dL 13.3–17.7 g/dL
White cell count 10.0.% 109 /L 3.9–10.6% 109 /L
Platelets 287 % 109 /L 150–440% 109 /L
Sodium 139 mmol/L 135–145 mmol/L
Potassium 3.9 mmol/L 3.5–5.0 mmol/L
Urea 4.3 mmol/L 2.5–6.7 mmol/L
Creatinine 88 &mol/L 70–120&mol/L
Cholesterol 5.0 mmol/L !5.5 mmol/L
Triglyceride 1.30 mmol/L 0.55–1.90 mmol/L
Very low-density lipoprotin (VLDL) 0.44 mmol/L 0.12–0.65 mmol/L
Low-density lipoprotein (LDL) 3.1 mmol/L 1.6–4.4 mmol/L
High-density lipoprotein (HDL) 1.9 mmol/L 0.9–1.9 mmol/L
His electrocardiogram (ECG) is shown in Fig. 92.1.
INVESTIGATIONS
II
I aVR V1 V4
V2 V5
III aVF V3 V6
II
aVL
Question
- What is the appropriate management?
Figure 92.1Electrocardiogram.