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 casual observation it is clear that Mr. O is almost 20 kilos overweight.
Since Mr. O has had no previous guidance on preventing heart disease, Mr. O's doctor has asked you to consult with his patient to help advise Mr. O both in the short and long term. You have already talked to Mr. O and discovered several points in his background that require further analysis and consideration. For example, you have learned that Mr. O's elder brother died of heart disease five years ago. You also have learned that Mr. O had once been a heavy cigarette smoker, but he has cut down his smoking from a pack a day to less than half a pack.
When you ask Mr. O if he often goes on hikes (as noted above, his heart attack occurred on a hiking trip), he tells you 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.
Since Mr. O's doctor has asked you to advise Mr. O on both his current condition and helping him improve his health prospects in the future, you want to consider these points:
1) What would be the most effective ways to inform Mr. O of his current health? (In answering this question, you will want to discuss Mr. O's current risk factors for another myocardial infarction.)
2) Because Mr. O delayed seeing a doctor when he suffered his first heart attack, you will want to help him prepare for the right kind of behavior in the event he should have another heart attack.
3) What should Mr. O do within the next few weeks to improve his health outlook?
4) What should he do in the longer term to help prevent the occurrence of another heart attack?
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