Sanjit
70, Male
History of Presenting Complaint (HPC)
Mr Patel was diagnosed with type 2 diabetes 15 years ago. Three years ago he developed shortness of breath on exercise which was associated with some vague discomfort in his chest. He was referred to the cardiologist by his GP and underwent coronary angiography. This revealed triple vessel atherosclerotic coronary artery disease and 2 arteries were treated with angioplasty and stent insertion. Last year his symptoms returned and following repeat angiography he was advised to have coronary artery bypass grafting.
Past Medical History:
Apart from the diabetes, Mr Patel has also been diagnosed with hypertension and stage 3b chronic kidney disease secondary to diabetic nephropathy. His creatinine on admission was 152 µmol/L giving him an eGFR of 42 ml/min.
Medications:
- Ramipril 5 mg od (ACE inhibitor, not currently prescribed)
- Clopidogrel 75 mg od (Anti-platelet agent, Stopped 2 days prior to admission)
- Metformin 500 mg bd (Sulphonylurea to control blood sugar, not currently prescribed, on an insulin sliding scale)
- Amlodipine 10 mg od (Calcium channel blocker, not currently prescribed as has been hypotensive)
- Bisoprolol 5 mg once a day (Beta blocker)
- Tazocin for presumed hospital acquired chest infection (piperacillin and tazobactam combination IV antibiotic)
- No known allergies
Family History:
His parents are both dead. His Father died aged 64 of ischaemic heart disease. His Mother died aged 82 from heart failure and diabetes. He has two sisters, one is 72 and also has type 2 diabetes and the other is 66 and well. He has three children aged 35, 37 and 40, all of whom are well, though the eldest has just been diagnosed with type 2 diabetes.
Social History:
He lives with his wife who is well. He has never smoked and doesn’t drink alcohol.