Mitsumasa Nakayama writes:
1. The effective ways to inform Mr.O
can be several patterns in discussing his current risk factors. One of
the most effective ways is to tell him some information which relates to
several diseases. Before telling him, I want to consider the most important
factors that influence his case. I would list these as his risk factors
about coronary disease - his age, high blood pressure, cigarette smoking,
high blood cholesterol, physical inactivity, overweight, heredity, and
being a male, etc. So he has many, many problems. Some of them seem inevitable
such as his age, sex and heredity. And then, about his age, I can tell
him that 45 percent of all heart attacks occur in people under age 65.
It is based on the Framingham Heart Study. In addition to that, about 80
percent of coronary heart disease mortality in people under age 65 occurs
during the first attack and in 48 percent of men who died suddenly of coronary
heart disease, there were no previous symptoms of the disease. In this
way, I can give some information. I think the most risky factor is high
blood pressure, so I also will give him information about this.
2. Sudden death occurs at from four to six times the rate of the general
population among people who've had a heart attack. He should know what
do when a heart attack. I think that if he experiences one or more symptoms
of a heart attack, he should act quickly and take the following steps.
First, sit down or lie down. If symptoms persist for 2 minutes, he should
call his local emergency telephone number and say he may be having a heart
attack. He should leave the phone off the hook so that medical personnel
can locate his address if he should become unconscious. Second, if he has
nitroglycerin tablets, he needs to take up to three pills, one at time
every 5 minutes. Third, ambulances are well equipped to provide emergency
care for people who are having heart attacks. It is usually better to have
medical personnel come to him than for him to start off for the hospital.
If he can get to the hospital faster by car than by ambulance, have someone
drive him. Do not drive himself-it could be dangerous. Fourth, do not delay
getting medical treatment, even if he is not sure he is having a heart
attack. A delay can cause permanent damage to his heart muscle or even
death. Let the doctor determine whether or not he is having a heart attack.
If his breathing or pulse stops, any person who is trained in cardiopulmonary
resuscitation (CPR) should immediately begin the procedure. Call his local
emergency telephone number first.
3. Mr. O should relieve hypertension. His dietary and lifestyle changes
may help control high blood pressure. Blood pressure also will be reduced
if he loses weight. And increasing physical activity can reduce blood pressure.
Before drugs are prescribed, these methods to control blood pressure are
often recommended for Mr.O with only mildly elevated blood pressure. And
he has to get a many knowledge of the heart attack such as medication.
Because getting prompt treatment for a heart attack can be lifesaving.
For instance, nitroglycerin is a drug that reduces the pain of angina by
widening blood vessels to allow more blood to reach the heart muscle. People
who have angina should have nitroglycerin with them at all times and should
take it immediately if they feel pain in their chest. Besides, he should
use drugs. The A.C.E inhibitors interfere with the body's production of
angiotensin, a chemical that causes the arteries to constrict. The calcium
antagonists can reduce the heart rate and relax blood vessels. Anymore,
he should reduce his LDL and increase his HDL. Excess cholesterol and unsaturated
fat collects in the linings of blood vessels, forming fatty deposits called
plaques. Over time, blood vessels may become clogged, reducing the blood
flow and oxygen supply to the heart muscle. Without sufficient oxygen to
the heart, this may cause chest pain, angina, or if the blood supply is
cut off, there is heart muscle injury and a heart attack, possibly resulting
in sudden death. Clotting or blockage in the head or neck can result in
a stroke.
4. In the long term if he thinks about it, he should change his life style
mainly. He once had been a heavy smoker, but he has cut down his smoking
from a pack a day to less than half a pack. But even if he cuts his cigarettes
to half, this is still bad for his heart. Smoking relates to many illnesses.
Nearly one-fifth of deaths from cardiovascular diseases are attributable
to smoking. It is also estimated that about 37,000- 40,000 nonsmokers die
each year from cardiovascular diseases as a result of exposure to environmental
tobacco smoke. So, it would be better for he to decrease the amount of
cigarette little by little. Another problem to prevent heart disease is
the cholesterol (This problem is linked with short term improvement.) It
is reported that among elderly Japanese-American men in the Honolulu Heart
Program Fourth Examination (1991- 93), 42 percent had cholesterol levels
greater than or equal to 200 mg/dL or were taking cholesterol-lowering
medication. As he can see from this report, decreasing his cholesterol
may be lead to preventing his possibility of another heart diseases. Cholesterol
is a type of fat made by his liver and it is also contained in certain
foods that he eats, such as eggs, meat and dairy products. When he eats
these foods often, the amount of cholesterol in his blood is increased.
Foods high in saturated fat can also raise the amount of cholesterol in
his blood, because his liver turns saturated fat into cholesterol. Cholesterol
travels through the blood in different types of packages called lipoproteins.
The low density lipoprotein (LDL) delivers cholesterol to the body. The
high density lipoprotein (HDL) removes cholesterol from the blood stream.
It is important for him to reduce LDL and increase HDL. To reduce fat,
trim away all visible fat and boil, bake, or broil rather than fry meats.
He can reduce dairy products he takes. He can use margarine instead of
butter. The third problem for him is that he is 20 kilos overweight (blood
pressure returns to normal in many obese people when they lose it). It
probably results from the fact that he hardly gets out of the office to
do exercise. The relative risk of coronary heart disease (heart attack)
associated with physical inactivity ranges from 1.5 to 2.4, an increase
in risk comparable with that observed for high cholesterol, high blood
pressure or cigarette smoking. Less active, less fit persons have a 30
- 50 percent greater risk of developing high blood pressure. To keep his
weight down, he needs to participate in routine physical exercise and control
his calorie intake. He should go to the hospital, have a his doctor check
him regularly and take an examination when the occasion demands.
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