Let’s refresh on the differential diagnosis of breast pain and swelling in a lactating woman, roughly in order from least scary to scariest. However, it’s important to have a basic understanding of lactation complications, since we often reassume primary responsibility for our patients a few weeks postpartum. 2010 Feb 4 362(5):471.Ĭase: 32yo female with hypothyroidism who is 10 weeks postpartum, presents to your office with left breast swelling and pain.Īs internists, we don’t see a lot of pregnancy-related complications, and have been known to phone an OBGYN friend at the sight of woman who is or has recently been pregnant. Ankle-brachial index and peripheral arterial disease. Outcomes in 45 patients with statin-associated myopathy.

2019 ACC/AHA Guidelines for the Primary Prevention of Cardiovascular Disease.Thanks, Collette, for guiding us through a great review of cardiovascular disease! 0.0-0.4 are associated with ulcers/gangrene.0.4-0.9 generally correlate with claudication.In fact, ABIs generally correlate with symptom severity: This patient was mostly having exertional symptoms, but also sometimes seemed to have symptoms at rest, which felt confusing, so we were reminded that when PAD is severe, patients often have pain at rest. Next, the patient got an ABI, which was grossly positive– turns out PAD-induced claudication was the culprit! Ok, so was it statin-induced myopathy causing the patient’s pain? Well…no. What is the time course for statin-induced myopathy? Two-thirds of patients will have onset of symptoms within six months of starting therapy, but it can happen at any time.Īnother great pearl we learned: those with hypothyroidism and vitamin D deficiency are at greater risk of statin-induced myopathy, so consider testing for these disorders in folks who do develop complications!ĭON’T FORGET: the ACC/AHA guidelines for primary prevention of CVD have been updated this year and now advocate for greater risk stratification and shared decision-making, particularly for those with intermediate risk (7.5-20%). Because these complications are so rare, routine monitoring of CK in patients on statins is not recommended. On the less severe side of the spectrum, <1% of patients on statins will develop rhabdomyolysis and 5-20% will develop myalgias. Statin-induced myonecrosis is something we fear and talk about constantly- but how common is it really? Turns out, it’s not! In fact, true myonecrosis is so rare that it’s not possible to quantify the prevalance. We reviewed the can’t miss diagnoses, including: Our initial differential was pretty broad in this woman who has multiple possible causes of bilateral leg pain.

We discussed a case of a 60 year old woman with poorly controlled diabetes c/b neuropathy, prior CVA and prior statin-related myalgias now back on statin, p/w months of chronic bilateral leg cramping without skin changes or weakness on exam.

Risk 7.5 full crack