Tetsuo Kato writes:
1) What would be the most effective
ways to inform Mr. O of his current health?
Some epidemiologic data show that people who survive the acute stage of
a heart attack have a high chance of illness and death that's two to nine
times higher than the general population. The risk of another myocardial
infarction, sudden death, angina pectoris, heart failure and stroke is
substantial. The history of a previous heart attack is the No.1 risk factor
in the case of Mr. O. So the first step is to make Mr. O aware of the seriousness
of the risk.
Consulting with and examining Mr.O, we also learned the following possible
risk factors for CVD, in addition to his history of heart attack.
(1) relatively high blood pressure: 165-105 mm Hg;
(2) negative cholesterol level: LDL -- 173 mm Hg; HDL -- 26 mm Hg;
(3) overweight by 20 kilos;
(4) family history of death by heart disease (his brother);
(5) used to be a heavy cigarette smoker and still smokes from a pack a
day to less than half a pack;
(6) lack of physical exercise.
These are believed through various researches and investigations to increase
greatly the possibility of mortality of CVD with correlations to the risk
factor of heart attack history. With enough information based on such scientific
data and evidence, I would explain to Mr. O that under this health condition
he is liable to suffer another heart attack, or chronic CVD even if he
could luckily escape another heart attack. As an executive of a business
company, he is expected to be intelligent and be able to understand the
relationship between these risk factors and CVD including heart attack.
As these risk factors mostly are attributable to his life style -- dieting,
smoking and exercising habits -- having him receive appropriate medical
treatment immediately and change the risky life style is essential for
prevention of CVD and reoccurrence of a heart attack. Though it will be
obviously difficult for him to change his habits, I would try to persuade
him to do so by emphasizing that his health condition is so severe that
he may lose his life if he were to suffer another heart attack or continue
to have CVD symptoms.
2) Because Mr. O delayed seeing a doctor when he suffered his first heart
attack, I will want to help him prepare for the right kind of behavior
in the event he should have another heart attack.
As mentioned above, Mr. O has a great possibility of suffering from another
heart attack in the near future. It is a must for a person who once experienced
heart attack to be sent to a medical facility as soon as he/she fells angina.
There is no exception for Mr. O's case, either. Therefore, if a heart attack
comes and persists for 2 minutes, Mr. O should be ready to call a local
emergency telephone number for ambulance. While waiting for the arrival
of an ambulance, it is important he sit down or lie down. More importantly,
Mr. O will be asked to always carry nitroglycerin tablets with him and
take up to three pills, one at a time every 5 minutes in case of heart
attack. He is never expected to act only by himself until he receives medical
consultation, which could be very dangerous.
3) What should Mr. O do within the next few weeks to improve his health
outlook?
Although he luckily survived the first heart attack, he has to seek some
medical assistance immediately and be very careful about another myocardial
infarction. He will be hospitalized to receive a test called an electrocardiogram
(ECG) and then a blood sample will be taken to test for chemicals that
are secreted by damaged heart muscles. He may be given drugs immediately
to help dissolve a clot that may be causing the blockage. If his heartbeat
is abnormal, the doctor may need to restore a normal rhythm with a defibrillator,
which delivers an electric current to your heart. He may also be given
blood-thinning medications to help prevent a clot from forming again or
to prevent new clots from forming. His care will continue in the coronary
care unit until out of danger. In order to reduce reoccurrence of heart
attack, diuretic medication to lower high blood pressure may be given to
him as well.
4) What should he do in the longer
term to help prevent the occurrence of another heart attack?
The most important way for Mr. O to protect himself from CVD including
heart attack is to change his life style into a much healthier one. As
mentioned earlier, he has at least five risk factors attributing to his
life style. In order to improve his health condition, the following advice
and suggestions on life style change will be given to him.
Daily physical exercise such as walking, jogging or cycling. That kind
of aerobic exercise assists him not only to strengthen cardiovascular function
but also to reduce weight and improve blood pressure from current high
pressure to normal level (around 102-70 mm Hg). However, it could be dangerous
to start heavy exercise right after a heart attack. He will be recommended
to begin with lighter exercise under supervision of his medical doctor.
Levels of HDL which is good cholesterol can also be improved with exercise.
Lower cholesterol diet. A high cholesterol level is positively correlated
with the incidence of various adult diseases including CVD and CHD. The
diseases are thought to occur via cholesterol's accumulation in arteries
and other tissues. Taking low cholesterol content food is one of the ways
to reduce LDL which gives cholesterol to arteries. Below are some ideas
and suggestions for lowering the cholesterol content in his diet.
To take (more):
--fruits and vegetables
--broiled or grilled fish and skinless chicken
--lean cuts when you eat beef, pork and lamb
--a variety of fiber rich foods, like oats, whole grain breads and apples
--low fat dairy products like skim
milk, no fat yogurt and ice milk
To limit:
--intake of saturated fats, like --dairy fats and palm and coconut oils
--high cholesterol foods, like --egg yolks and liver
--eating fried foods
Refraining from smoking. There is an estimate that nearly one-fifth of
deaths from CVD are attributable to smoking. He has greatly reduced the
number of cigarettes he smokes a day. But he still smokes half a pack a
day, that is relatively a lot. He may have to recognize harmful effects
of smoking again knowing the fact that environmental tobacco exposure increases
death of CHD by about 30%.
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