Hypercholesterolemia

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Returns for a ‍dyslipidemia follow-up

Last visit was ‍ ‍months ago



Current symptoms: ‍none

‍chest pain, ‍retrosternal, ‍aching, ‍on exertionat restwith deep breath, ‍mild

‍shortness of breath

‍fatigue

‍decreased exercise tolerance

‍dizziness

‍palpitations

‍syncope

‍lower extremity edema, ‍rightleftsymmetrical

‍weight gain, ‍ ‍lbskg over ‍ ‍weeksmonths

‍orthopnea

‍paroxysmal nocturnal dyspnea



Diet: ‍goodaveragepoor, ‍high in salt, ‍high in carbs, ‍high in fat, ‍vegan

Physical activity: ‍adequateaveragesedentary

Weight: ‍ ‍lbskg, ‍gainunchangedloss

Smoking: ‍neversmokerformer smoker, ‍ pack-years

Alcohol: ‍nonereasonableexcessive, ‍ drinks per ‍dayweek

Recreational drugs: ‍none ‍cannabis, ‍IVDU



Contributing factors:

no history of: ‍coronary artery disease, ‍diabetes, ‍hypertension, ‍hyperlipidemia, ‍stroke



Medications:

‍statins, ‍Fibrates, ‍Niacin, ‍Bile acid sequestrants, ‍Omega-3 fatty acids, ‍PCSK9 inhibitors

Adherence: ‍goodaveragepoor, ‍adverse effects



Labs: ‍unremarkable

Cholesterol: ‍ ‍normal

LDL: ‍ ‍normal

HDL: ‍ ‍normal

Triglycerides: ‍ ‍normal

HbA1c: ‍ ‍normal

TSH: ‍ ‍normal





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Metrics: weight: ‍ ‍kglbs, height: ‍ cm, waist: ‍ cm, BMI: ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions

Extremities: ‍warm, ‍dry, cap refill ‍< 3> 3 sec, pulses ‍intact, ‍edema ‍bilaterally, ‍





ASSESSMENT:

‍Dyslipidemia ‍likelysuspectedpossible, ‍well-controlled

DDx: hyperlipidemia, familial hypercholesterolemia, hypothyroidism, alcohol abuse, nephrotic syndrome, chronic kidney disease,





PLAN:

Investigations:

- Blood work: ‍CBC, ‍lytes, ‍creatinine, ‍glucose, ‍HbA1c, ‍lipid profile, ‍TSH

Treatments:

- ‍Statins

- ‍Fibrates

- ‍Niacin

- ‍Omega-3 fatty acids

- ‍Bile acid sequestrants

- Healthy diet (low in salt, carbs and fat)

- Regular exercise

- Weight loss counseling

- Limit alcohol intake

- Smoking cessation

Further care:

- Referral to dietitian

- Repeat lipid profile in ‍ ‍monthsyears

- Follow-up in ‍ ‍monthsyears