Cardiovascular care in an increasingly diverse community.

Cardiovascular care in an increasingly diverse community represents a distinct challenge for cardiovascular medicine, the following cases illustrate these challenges. Case Presentation: A 66-year-old black woman arrives at her local emergency department in the southern United States. She works as a full-time secretary and has a history of poorly controlled hypertension despite several attempts at combination drug treatment therapies. She presents with chest pain and shortness of breath. Her antihypertensive regimen is adjusted, and she is given a follow-up appointment to see her usual physician. She returns in 2 weeks with new-onset heart failure (HF) status post old acute myocardial infarction. Case Presentation: A 72-year-old Hispanic woman visits her primary care physician. She has previously been diagnosed with diabetes mellitus, hypertension, and kidney disease. She speaks only Spanish, but the translator is not available owing to illness. The patient tells her physician that she has been experiencing shortness of breath and complains of no other symptoms. The patient is given a diuretic and a return appointment. She is admitted 3 days later with decompensated HF. Case Presentation: A 52-year-old stoic Southeast Asian man, a practicing physician, reports to a colleague the sudden onset of chest pain. He has had no previous diagnoses and exhibited no risk factors before the event. He is reassured and a routine exercise treadmill test is ordered. Within 24 hours, he experiences sudden cardiac death.