Problem-Based Question: Clinical case of Hypertension, Mild paroxysmal supraventricular tachycardia (PSVT), and Hyperlipidemia.

Problem-Based Question:

A 51-year-old male presents to the clinic for a routine follow-up. He has a medical history of hypertension, mild paroxysmal supraventricular tachycardia (PSVT), and hyperlipidemia. He is asymptomatic today but expresses concern about long-term cardiovascular risks. His blood pressure in the clinic is 148/92 mmHg. Recent lipid profile shows LDL cholesterol of 165 mg/dL, HDL 38 mg/dL, and total cholesterol 240 mg/dL. He has had several brief episodes of palpitations over the past 6 months, which resolved spontaneously. ECG shows normal sinus rhythm with occasional PACs.

What should be the appropriate pharmacologic plan for this patient, considering all comorbidities?

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Answer:

1. Hypertension Management:

• First-line pharmacologic treatment:

  • Beta-blocker such as metoprolol is a good option since it can help manage both hypertension and PSVT by controlling heart rate and suppressing arrhythmias.

  • Alternatively, calcium channel blockers like verapamil or diltiazem are also effective for both hypertension and PSVT.

• Goal BP: <130/80 mmHg (especially given multiple cardiovascular risk factors).

2. PSVT Management:

• Mild PSVT episodes that are infrequent and self-limiting may not require aggressive treatment.

• Beta-blockers or non-dihydropyridine calcium channel blockers can be used for prophylaxis.

• Patient education: Teach vagal maneuvers (e.g., Valsalva) to abort episodes when they occur.

• If episodes become more frequent or symptomatic, electrophysiology referral for potential catheter ablation can be considered.

3. Hyperlipidemia Management:

• Based on his age and elevated LDL, and given his hypertension and arrhythmia, he qualifies for moderate- to high-intensity statin therapy per ACC/AHA guidelines.

  • Start with atorvastatin 20–40 mg or rosuvastatin 10–20 mg daily.

• Monitor lipid profile in 6–12 weeks and adjust dose accordingly.

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