Vaskulärer Fall: 72-jähriger Mann mit Fußschmerzen und Gangrän am linken Hallux von Joseph Alpert, MD

A 72-year-old man is admitted to the cardiology service because of severe foot pain and a gangrenous left hallux. He has a personal history of untreated type II diabetes mellitus, hypercholesterolemia, and hypertension. He has smoked one pack of cigarettes a day for 50 years. On physical examination, the patient is obese, his blood pressure is 165/72 mm Hg, heart rate is 78/min, and peripheral oxygen saturation is 92%. Femoral pulses are weak, dorsalis pedis pulses are not felt, and the left hallux is gangrenous. On chest auscultation, an early systolic ejection murmur is heard best at the upper right sternal border. Laboratory studies show an elevated blood glucose level with an HbA1c level of 10.4%. Creatinine is 1.9 mg/dL, total cholesterol is 298 mg/dL, HDL is 29 mg/dL, LDL is 201 mg/dL, and triglyceride is 505 mg/dL. His triglycerides level was at 505 mg/dL. This patient’s current vascular condition is most likely associated with which of the following?

A 72-year-old man is admitted to the cardiology service because of severe foot pain and a gangrenous left hallux. He has a personal history of untreated type II diabetes mellitus, hypercholesterolemia, and hypertension while he also reports 50 pack-years of smoking history. On physical examination, the patient is obese, his blood pressure is 165/72 mm Hg, heart rate is 78/min, peripheral oxygen saturation is 92%, femoral pulses are weak while dorsalis pedis pulses are not felt bilaterally and the left hallux is gangrenous. On chest auscultation, an early systolic ejection murmur is heard best at the upper right sternal border. Laboratory blood test reveals an elevated blood glucose level with an HbA1c level at 10.4 mg/dL, creatinine is 1.9 mg/dL, total cholesterol is 298 mg/dL with HDL at 29 mg/dL and LDL at 201 mg/dL. His triglycerides level was at 505 mg/dL. Which of the following valvular conditions is most likely present in this patient?

A 72-year-old man is admitted to the cardiology service because of severe foot pain and a gangrenous left hallux. He has a personal history of untreated type II diabetes mellitus, hypercholesterolemia, and hypertension while he also reports a 50-pack-years smoking history. On physical examination, the patient is obese, his blood pressure is 165/72 mm Hg, heart rate is 78/min, peripheral oxygen saturation is 92%, femoral pulses are weak while dorsalis pedis pulses are not felt bilaterally and the left hallux is gangrenous. On chest auscultation, an early systolic ejection murmur is heard best at the upper right sternal border. Laboratory blood test reveals an elevated blood glucose level with an HbA1c level at 10.4 mg/dL, creatinine is 1.9 mg/dL, total cholesterol is 298 mg/dL with HDL at 29 mg/dL and LDL at 201 mg/dL. His triglycerides level was at 505 mg/dL. Which of the following is the best next step in management?