Case on Metabolic Syndrome

8/9/2019 Case on Metabolic Syndrome

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SGD 3Sweet and High Disposition

Metabolic Syndrome

D2


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What are the salient features ofthis case?

59/M

CC: right sided weakness

Nape pain and headacheSlurring of speech

Hypertensive for 5 yrs, M for 5 yrs!no "aintenance "edications#

$H: $ather !%# H&N, Mother !%# M'( pack yrs

!%# polyuria, !%# polydipsia, !%# polyphagia

!%# )u))ly urine, !%# inter"ittency

Su)*ectiveata


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What are the salient features ofthis case?

+)*ectiveata

Conscious, coherent, !%# dysarthria

BP: 210120! "#: $$min! ##: 1$min

Height %%! &eight200 lbs

'pe( beat at )th*+"S ''*! s,stained! di-,sed

Grade 3) early systolic m,rm,r at the ape(

'bdomencentral obesity! waist circ,m.erence o. 110cm

2% MM/ right ,pper and lower e(tremities

#ight .acial asymmetry


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Patients BM+ 01 g 1)%m42

335 gm42

Compute for the patients BMI


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5

Discuss BMI Classication basedon WHO

ody Mass -nde. !M-#'sia6Paci7c obesity

classi7cation


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5 +s this case ahypertensi8e emergency

or ,rgency9Sal8osa! atrina Marie M


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Hypertensi8e ,rgency

BP is se8erely ele8ated

Systolic: 1$0 or higher

Diastolic: 110 or higher

;o associated organ damage

Symptoms:

Se8ere headache

Shortness o. breath

;osebleeds

Se8ere an(iety


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Hypertensi8e emergency

Malignant Hypertension

BP is se8erely ele8ated

Systolic: 1$0 or higher Diastolic: 120 or higher

"an be lower in patients whose bp hadnot been pre8io,sly high

'br,pt s,dden onset

&ith associated organ damage

patient


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% &hat are the possible

target organ damage thatco,ld be present in

hypertensi8e emergency andi. which among these were

present in this patient i.

theres any9Sal8osa! atrina Marie M


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/arget organ damage

"ardio8asc,lar! #enal! P,lmonary

Stroe

*oss o. conscio,sness

Memory loss Heart atttac

Damage to the eyes and idneys

*oss o. idney .,nction

'ortic dissection

'ngina

P,lmonary edema

eclampsia


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Patient

BP on physical e(amination: 210120

"c: right sided weaness

MM/: 2%! right ,pper and lowere(tremities

&ith sl,rring o. speech

&ith right .acial assymetry stroe


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0 1hat are the cardiovascular riskfactors and identify which a"ong therisk factors are present in thispatient2

Modifable risk actors

Hypertension

'bnormal blood lipid le8els!

high total cholesterol

high le8els o. triglycerides

high le8els o. low6density lipoprotein

low le8els o. high6 density lipoprotein besity

/ype 2diabetes

Diethigh in sat,rated .at


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Modifable risk actors

Being poor

' chronically stress.,l li.e

social isolation

'n(iety

Depression

'lcohol cons,mption

one to two alcohol drins a day may lead to a 30? red,ction in heart disease!

b,t abo8e this le8el alcohol cons,mption will damage the heart m,scle

"ertain medicines

contracepti8e pill and hormone replacement therapy


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Non-Modifable risk actors

'ge

ris o. stroe do,bles e8ery decade a.ter age %%

Aamily History

+. a 7rst6degree blood relati8e has had coronary heart disease or stroebe.ore the age o. %% years


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01/28/15


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30 How do you "anagehypertensive e"ergency vs

hypertensive urgency2 !4NC #H6&787NS-7 7M78;7NC6 H6&787NS-7


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90 1hat is the reco""endeddrug of choice in this

patient2 !4NC #

sc,ss e a gor m or e


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sc,ss e a gor m or etreatment o. hypertension


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scuss e recommen a on or


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scuss e recommen a on ormanagement of hypertension based on

!C "

scuss e recommen a on or


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scuss e recommen a on ormanagement of hypertension based on

!C "


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+)esity is the driving force

)ehind "eta)olicsyndro"e, therefore weight

reduction is the pri"ary

approach to this disorder

MBNB;7M7N +$ M7B+-CS6N8+M7

MBNB;7M7N +$ M7B+-C


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MBNB;7M7N +$ M7B+-CS6N8+M7

-$7S67

F;"6C: 1500! DM: 130$0

low sodi,m! high potassi,mhigh6,ality

&HB8MBC++;-C/S


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29

17-;H MBNB;7M7N

Diet'8oid diets enriched in sat,rated .atsPhysical acti8ity

High ris patients sho,ld ,ndergo .ormal "@ e8al,ationbe.ore initiating an e(ercise program 30 mins can be bene7cialto obese patients o. moderate intensity

Beyond li.estyle modi7cation1 &eight loss dr,gs

appetite s,ppressants


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6S-&-7M-B

statins


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+MP'+#D A'S/+;G G*K">S

Glycemic controlimpro8e .asting/G and or HD* cholesterol le8els

*i.estyle modi7cation

+AG witho,t DM type

&eigh red,ction! dietary .at restriction!increase physical acti8ity

M/A>#M+;

red,ce incidence o. /ype ++ DM


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-nsulin 8esistance

iguanide andhiaDolidinediones+ncrease ins,lin sensiti8ity

nhance ins,lin action in li8erS,ppress endogeno,s gl,cose prod,ction

#ed,ce marers o. inQammation and smalldense *D*

-hiaolidinediones impro,e insuline medicatedglucose upta/e in muscle and adipose tissue


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01/28/15

&hat are the possible complications o.hypertension in this patient i. le.t

,ntreated9

Stroe *oss o. conscio,sness Memory loss

Heart attac Damage to the eyes and idneys *oss o. idney .,nction 'ortic dissection

'ngina P,lmonary edema clampsia


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01/28/15

+s metabolic syndrome present in thispatient9 &hat criteria did the patient

.,l7ll9

Jes 'ccording to the ;"P


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How do yo, manage metabolicsyndrome9

Goals o. /herapy:

#ed,ce cardio8asc,lar disease andrenal morbidity and mortality


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H&N: /reat BP 1500 or BP 130$0 inpatients with diabetes or chronic idneydisease 'chie8e SBP goal especially inpersons older than %0 years o. age

1eight Manage"ent: *i.estyle Modi7cation &eight red,ction: %620 mmHg 10 g weight

loss

Physical acti8ity: 30 min,tes o. aerobice(ercise .or 5( a wee Moderation o. alcohol cons,mption: 3 oN o.

alcohol


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yslipide"ia: *D* red,ced to100mgd*! diet restricted in sat,rated.at! trans .at and cholesterol +. *D*remains abo8e goal! ,se statins!

eNetimibe or cholestyramine /riglyceride8al,e o. 1%0 mgd*! weight red,ction o.10?! 7brate! omega63 .atty acids andstatins can be ,sed

M/ -nsulin resistance: glycemiccontrol! weight red,ction! .at restriction!increased physical acti8ity Big,anides!

/ODs can increase ins,lin sensiti8ity

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Case on Metabolic Syndrome