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VOLUME 1 ISSUE 6 CASE MP	MP is a 60-year-old Hispanic woman who has recently been diagnosed with type 2 diabetes mellitus.
PHYSICAL EXAMINATION »  Height: 5 ft. 3 in. »  Weight: 180 lb. »  BMI: 32 kg/m2 »  Pulse: 81 »  Blood pressure: 140/75 mm Hg LABORATORY VALUES »  TC: 240 mg/dL »  LDL-C: 160 mg/dL »  HDL-C: 30 mg/dL »  Triglycerides: 250 mg/dL »  FPG: 160 mg/dL »  A1c: 8.0% CURRENT MEDICATIONS »  Ramipril: 5 mg/d »  Atorvastatin: 10 mg/d »  Metoprolol: 50 mg/d »  Aspirin: 325 mg/d NAVIGATION »  Q1: What is the risk for edema with the use of TZDs? »  Q2: What is the pathogenesis of TZD-associated edema? »  Q3: What is the pathogenesis of CHF with TZD use? »  Q4: What is the risk for CHF in persons using TZDs? »  Q5: How would you evaluate the risk for edema in MP? »  Q6: What if MP had mild New York Heart Association (NYHA) class I or II CHF? Would a TZD be contraindicated? »  Q7: What if MP had NYHA Class III or IV CHF? »  Q8: How should you evaluate this patient? »  Q9: MP shows no signs or symptoms of CHF at this visit, and her weight is stable. How should you proceed?	Follow-Up Visit At a 1-month follow-up visit, you notice slight pedal edema. Q: How should you evaluate this patient? A: Pedal edema does not necessarily represent CHF. You should evaluate MP for any symptoms of CHF (Table 3, Figure 1)1 and perform a physical examination. Give emphasis to finding signs of CHF such as jugular venous distension, pulmonary rales, or an S3 heart sound. Search for other causes of edema in the clinical history before attributing it to TZD therapy. If CHF is suspected, consider obtaining an echocardiogram. If a new diagnosis of CHF is made or considered likely, reconsider the use of the TZD and start treatment for CHF according to the newest treatment guidelines.
	Questions? Contact 1-888-JEFF-CME (533-3263) or http://jeffline.jefferson.edu/jeffcme
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