Coronary artery disease

Patient is 72-year-old male who states that in February 2016 he had a severe angioedema attack that led to intubation in ICU for three days and then two weeks of rehabilitation in a nursing home. He does have a history of medical conditions that he is being treated for with multiple medications. He did have another event in October 2015 that caused some tongue and facial swelling. He did go to the ER and got an administration of epinephrine and this cleared it up. He did not have to be hospitalized at that time. He was taking lisinopril at that time and they discontinued that and were hoping that that was the cause. He has not changed any of his medications recently. He has been on all of them for many years. He does take Aleve a couple of times per week. Other medications currently include metoprolol, amlodipine, VESIcare, omeprazole, levothyroxine, Azilect, Aggrenox, tamsulosin, sertraline, Sinemet, allopurinol, Norco, and none of these have been changed or adjust in dosages recently and none of these are specific risk factors for angioedema except for the Aleve that he takes twice weekly. He does not notice that he has any swelling or irritation associated with taking Aleve.

He does not have any history of allergies seasonally or perennially, any food allergies or delayed hypersensitivity to chemicals, fabrics, soaps or other products. He denies any trouble with chronic infection, frequent bad cold, or frequent tonsillitis. He did not feel that he has had any sicknesses lately or any infections.

He denies any ear troubles including frequent infections, dizziness or lightheadedness. He denies any eye irritation, redness, tearing, burning, eyelid swelling, or yellow discharge from eyes. He denies any troubles with wheezing or lung problems in the past. He has never been evaluated for allergies before.

ASSESSMENT:
1. Angioedema unspecified. Differential include chronic idiopathic angioedema versus acquired angioedema versus medication allergies.
2. Parkinson’s disease.
3. Coronary artery disease.
4. Diabetes mellitus.
5. Hypothyroidism.
6. Gouty arthritis.
7. Osteoarthritis.

PLAN:
1. At this time, I would like to do some screening blood work to see if he does have any acquired angioedema. This will include anti-C1q, C1q, C1 inhibitor, antigenic level and function, serum tryptase, CBC with differential count, ANA, CMP, ESR, CRP, and C4. This will help screen for hereditary or acquired angioedema and any secondary comorbidities that may be contributing to the arrival of this.
2. I will call when we will get blood work back.
3. I do not feel that his medications are at fault at this time as he is not on any that are at risk factor for developing angioedema. He does have an EpiPen to use just in case and he is told to go to the emergency room right away if he does have a swelling event again.
4. We will follow up when we will get lab work back and provide treatment accordingly.

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