Shinichiro Teranishi writes:
Patient Okada (O) is a 47-year-old
Kobe business executive who suffered a mild myocardial infarction two months
ago while on a hiking trip in Shizuoka. He had been unaware of any CVD
problems before his heart attack and, in fact, he visited his doctor only
after he returned to Kobe, two days after his attack. His wife insisted
that he see a doctor even though Mr. O thought "everything was back
to normal, and now I'm feeling fine."
Mr. O is not in good health. While he is still relatively young, his blood
pressure indicates moderate to high hypertension, 165-105 mm Hg. Mr. O's
doctor reports that the results of cholesterol tests are not positive:
LDL -- 173 mg/dl; HDL -- 26 mg/dl. Furthermore, Mr. O now complains of
sharp chest pains that sometimes occur right after his dinner meals, a
clear symptom of angina pectoris. And from causal observation it is clear
that Mr. O is almost 20 kilos overweight.
First of all, Mr. O must realize the serious condition he is in now. Mr.
O complains of sharp chest pains, which is a clear symptom of angina pectoris.
Mr. O's elder brother died of heart disease five years ago, which means
he has quite a big chance of developing heart disease. Mr. O needs to start
paying attention to his own health right now, otherwise he will get a fatal
heart disease and could die of it. I think it is time for Mr. O to be conscious
of having many risk factors of heart disease. Mr. O is no longer so healthy
or so young as he thinks.
First, Mr. O has suffered a mild heart attack and now has angina. Angina--a
feeling of pain, heaviness, tightness, burning, or squeezing in your chest--is
an indication that a person has heart disease and is at risk of having
a heart attack. Angina occurs when the heart muscle does not receive enough
oxygen because of a temporary narrowing of one of the coronary arteries
that supply it with oxygen-rich blood. Angina usually occurs during physical
exertion or emotional stress. Mr. O had better talk about his heart attack
with his doctor immediately and discuss if he had had any symptoms of angina,
which are similar to those of an actual heart attack. Prompt treatment
for angina can prevent him from having a heart attack. Many people experience
angina for years, but do not seek treatment and eventually have a heart
attack.
Additionally, Mr. O's blood pressure is very high. Because medical science
doesn't understand the causes of most cases of high blood pressure, it's
hard to say how to prevent it perfectly. Still, several factors may contribute
to it. For example, obesity, sodium (salt), age and heredity are factors
increase the chance that a person will develop high blood pressure. Being
overweight or using excessive salt are two avoidable factors. Age is one
risk factor that can't be changed. Generally speaking, the older people
get, the more likely they are to develop high blood pressure. Heredity
is another factor. People whose parents have high blood pressure are more
likely to develop it than those whose parents don't. Other related factors
contribute to high blood pressure is sedentary or inactive lifestyle. 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. Mr. O says that he hardly gets
out of the office to do exercise. He is a devoted company employee who
works six and sometimes seven days a week. His only exercise is walking
across the street from his apartment to his office and back. I can say
that physical inactivity is a risk factor for him, too.
Another important issue for Mr. O's prognosis is to change his blood cholesterol
count, that is, to reduce his LDL and increase his HDL. It is highly possible
that his high blood cholesterol level increases risk of coronary heart
diseases or other adult diseases. He should avoid eating high cholesterol
foods such as eggs, cheese, and fatty meats as much as he can. Animal fats
include cholesterol and much saturated fatty acids, and saturated fatty
acids lead to high blood cholesterol. Mr. O should recognize that his blood
cholesterol level is abnormal now.
I think Mr. O had no previous guidance on preventing heart disease. So,
I will advise him about what to do for preventing the occurrence of another
heart attack. And, I will show Mr. O general guidelines to improve his
health outlook. Mr. O had better carry out the following improvements at
once.
1) I encourage Mr. O to stop smoking. As people age, the walls of their
arteries gradually thicken, and some study shows that cigarette smoking
accelerates the process by more than a decade. By adding the equivalent
of 10 years of aging to his arteries, the smoker is increasing his risk
of stroke and heart attack.
2) I encourage Mr. O to eat more high-fiber foods such as whole grain cereals,
legumes, vegetables, and fruits and low-in-cholesterol foods such as chicken,
fish, and tofu. (This is Japanese traditional food. Tofu is made from soybean.
So it contains high protein and low cholesterol.) He should try these foods,
because taking fiber-rich foods and cutting down on total fat intake reduces
your cholesterol level, and moreover lowers your blood pressure.
3) I recommend that Mr. O reduce the intake of sodium. Some people with
mild hypertension can lower their blood pressure by reducing sodium in
their diet.
4) I would highly recommend Mr. O maintain a healthy weight. Blood pressure
also returns to normal in many obese people when they lose weight. The
weight that's right for him is almost 20 kilos under his weight in the
present state. Excess body fat increases his chances for high blood pressure,
heart disease, stroke, and other illnesses. A registered dietitian can
help him develop sensible eating habits for successful weight management.
Regular exercise is also important to maintaining a healthy weight. In
addition, I recommend Mr. O do fast walking for about 30-60 minutes. I
think fast walking is one of the better ways for maintaining our good health.
Because exercising burns body fats and cholesterol level lower.
Dietary and lifestyle changes may help control high blood pressure. But
Mr. O has to remember that if he carries out these improvement, the changing
in his body does not take effect soon. It takes a lot of time to change
the condition in his body. Mr. O must try to continue to stop smoking,
take healthy foods, have a good exercise and so on. In short, these improvements
need a long time to work. The most important thing is for Mr. O to keep
the guidelines in the long term for preventing heart disease.
When I prescribe drugs, I must pay attention to the following. Many medications
known as antihypertensives are available to lower high blood pressure.
In most cases, drugs to lower blood pressure is effective. But quite often
people respond very differently to these medications. Thus most patients
must go through a trial period to find out which medications are most effective
while causing the fewest side effects.
Finally, I will tell Mr. O what he should do if he has the symptoms of
a heart attack. This is because getting prompt treatment for a heart attack
can be lifesaving. So, I advise Mr. O, if he experiences one or more symptoms
of a heart attack, to act quickly and take the following steps:
1) Sit down or lie down.
2) If symptoms persist for 2 minutes, call your local emergency telephone
number and say you may be having a heart attack. Leave the phone off the
hook so that medical personnel can locate your address if you should become
unconscious.
3) If you have nitroglycerin tablets, take up to three pills, one at a
time every 5 minutes.
4) 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 you than for you to start off for the hospital.
5) If you can get to the hospital faster by car than by ambulance, have
someone drive you. Do not drive yourself--it could be dangerous.
6) Do not delay getting medical treatment, even if you are not sure you
are having a heart attack. A delay can cause permanent damage to your heart
muscle or even death. Let the doctor determine whether or not you are having
a heart attack.
7) If your breathing or pulse stops, any person who is trained in cardiopulmonary
resuscitation (CPR) should immediately begin the procedure. Call your local
emergency telephone number first.
8) When you arrive at the emergency room, you or the person who brought
you should announce clearly that you may be having a heart attack. Make
sure you are seen at once.
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