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Telehealth Follow-Up for Fatigue and Bradycardia
During a scheduled telehealth video consult, a 65-year-old man with a history of coronary artery disease and hyperlipidemia reports feeling increasingly fatigued and short of breath with minimal activity over the past two weeks. His medication regimen was recently adjusted to include metoprolol for hypertension, which he started three weeks ago. He denies chest pain but feels lightheaded when standing quickly. Review of his home blood pressure monitor shows a current reading of 126/76 mmHg and a heart rate of 47 bpm, a significant drop from his baseline of 163/98 mmHg and 67 bpm recorded before starting the new medication.
Elderly Woman with Fatigue and Dizziness on Metoprolol
A 73-year-old woman with a history of essential hypertension and hyperlipidemia presents for a routine follow-up. She reports a 2-week history of increasing fatigue, dizziness, and mild shortness of breath with routine household chores. Her hypertension was diagnosed 2 months ago, and she was started on metoprolol 60 days ago. Her blood pressure has improved from a baseline of 163/91 mmHg to 125/82 mmHg today. On examination, her heart rate is 39 bpm and regular. Her baseline heart rate was 67 bpm. Her creatinine clearance is 75 mL/min.
Abdominal Pain in a Hypertensive Patient on Lisinopril
A 58-year-old woman with a history of essential hypertension and hyperlipidemia presents with a 3-week history of severe, cramping abdominal pain, nausea, and intermittent vomiting. Her hypertension was recently initiated on lisinopril, and her blood pressure has improved from 164/95 mmHg to 135/78 mmHg. Physical examination reveals a soft but diffusely tender abdomen without guarding or rebound tenderness. A CT scan of the abdomen and pelvis shows asymmetric, segmental thickening of the small bowel wall with associated luminal narrowing. Her heart rate is 68 bpm and her creatinine clearance is 85 mL/min.
Acute Kidney Injury After Lisinopril Initiation
A 42-year-old woman with a history of essential hypertension and hyperlipidemia presents for a follow-up visit. She was started on lisinopril 21 days ago. While her blood pressure has improved from 142/88 mmHg to 134/82 mmHg, she reports feeling fatigued. Laboratory evaluation reveals a rapid rise in her serum creatinine and blood urea nitrogen (BUN), consistent with new-onset azotemia and oliguria.
Hypertensive Patient with New-Onset Diarrhea
A 42-year-old woman with a history of essential hypertension and hyperlipidemia presents for a routine follow-up. Her blood pressure, previously 142/88 mmHg, is now well-controlled at 134/82 mmHg on her current regimen. Two weeks ago, her primary care physician initiated lisinopril for better blood pressure management. She has no other new medications, dietary changes, or recent travel. She reports no fever, abdominal pain, or blood in her stool.
Hypertensive Patient with New Onset Dizziness
A 58-year-old woman with a history of essential hypertension and hyperlipidemia presents for a follow-up visit. Her blood pressure is now well-controlled at 134/82 mmHg on lisinopril, which was initiated 4 weeks ago. She reports experiencing episodes of lightheadedness and unsteadiness, particularly when standing up quickly. She denies chest pain, palpitations, or focal neurological deficits. Her heart rate is 72 bpm and her creatinine clearance is normal.