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Internal Medicine

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Clinical Science

Abstract

Texas houses the largest uninsured population in the US with an estimated 5 million residents lacking healthcare. In the Rio Grande Valley, the combination of poverty, limited access to care, and lack of insurance poses a great barrier to healthcare management.

Patient is a 27-year-old female with a past medical history of Takayasu arteritis, migraine headaches, complete heart block with pacemaker placement, heart failure with reduced EF of 20%, and rheumatic heart disease s/p mitral valve replacement. Patient presented to the ED with a one-day history of a headache located on the right side of her head and face, described as pounding, and 7/10 in intensity with associated photosensitivity and nausea. She did not have a PCP, and did not receive regular care. Physical exam on admission revealed a difference in SBP of 20 mmHg between the right arm (117) and left arm (137). CT head revealed no acute findings. Further workup included a diagnostic cerebral angiogram which revealed stenosis of the left common carotid artery origin greater than 90%.

This patient's limited access to care due to immigration, financial and insurance status, demonstrates how social determinants of health can impact a disease like Takayasu arteritis. Lack of routine management resulted in unhalted disease progression with extensive stenosis of her carotid artery and inflammation of vasculature, further complicated by a subtherapeutic INR and multiple unmanaged comorbidities. This case highlights the importance of recognizing and addressing patient barriers to healthcare, thereby minimizing potential complications of disease.

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Effects of Social Determinants of Health on Disease Burden in a case of Takayasu Arteritis

Texas houses the largest uninsured population in the US with an estimated 5 million residents lacking healthcare. In the Rio Grande Valley, the combination of poverty, limited access to care, and lack of insurance poses a great barrier to healthcare management.

Patient is a 27-year-old female with a past medical history of Takayasu arteritis, migraine headaches, complete heart block with pacemaker placement, heart failure with reduced EF of 20%, and rheumatic heart disease s/p mitral valve replacement. Patient presented to the ED with a one-day history of a headache located on the right side of her head and face, described as pounding, and 7/10 in intensity with associated photosensitivity and nausea. She did not have a PCP, and did not receive regular care. Physical exam on admission revealed a difference in SBP of 20 mmHg between the right arm (117) and left arm (137). CT head revealed no acute findings. Further workup included a diagnostic cerebral angiogram which revealed stenosis of the left common carotid artery origin greater than 90%.

This patient's limited access to care due to immigration, financial and insurance status, demonstrates how social determinants of health can impact a disease like Takayasu arteritis. Lack of routine management resulted in unhalted disease progression with extensive stenosis of her carotid artery and inflammation of vasculature, further complicated by a subtherapeutic INR and multiple unmanaged comorbidities. This case highlights the importance of recognizing and addressing patient barriers to healthcare, thereby minimizing potential complications of disease.

 

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