100 Cases in Clinical Medicine

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.