Minoru Kameoka writes:
      
      
      
1) We should inform him of the fact
        that heart attack is the single largest killer of males and females in
        the developed world. And a sudden death occurs at from four to six times
        the rate of the general population among people who have had a heart attack.
        Besides this fact, we must explain the details of myocardial infarction.
        To illustrate, a myocardial infarction 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. The area of heart
        muscle that does not receive blood begins to die. The seriousness of a
        heart attack depends on how much of the heart is affected. Therefore, he
        must go to a hospital as soon as possible when he has another heart attack.
        
        
        On the other hand, he should know the risk factors about another myocardial
        infarction too. He has five factors for coronary disease: cigarette smoking,
        high cholesterol, physical inactivity, being overweight, hypertension.
        Because a coronary disease has a close relation to a myocardial infraction,
        he must avoid these things. Also, he had better know that a myocardial
        infarction occurs during physical exertion or emotional stress. 
        
        2)I think the reason why he delayed seeing a doctor was he was not sure
        it was a heart attack. To tell the truth, heart attack symptoms can be
        vague. Therefore we should suggest several things, for example, getting
        prompt treatment for a heart attack can be lifesaving. If he experiences
        one or more symptoms of a heart attack, he should act quickly and take
        the following steps. "At first, sit down or lie down. 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.
        If you have nitroglycerin tablets, take up to three pills, one at a time
        every 5 minutes. 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. 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. "
        
        The best thing he can do, overall, when he has another heart attack is
        to go to the hospital. 
        
        3) Mr. O, I think, should be sure to follow his regular doctor's instructions.
        Stay on his medication. He would be given some tablets, nitroglycerin probably.
        Nitroglycerin is a drug that reduces the pain of angina by widening blood
        vessels to allow more blood to reach the heart muscle. He should place
        nitroglycerin tablets under his tongue whenever he feels the pain of angina
        or anticipates it coming on. People who have angina should have nitroglycerin
        with them at all times and should take it immediately if they feel pain
        in their chest. 
        
        4) As mentioned before, high blood pressure is one of the large causes
        of myocardial infarctions. So, after provisional cures, for instance, medication,
        he should take other cures. Dietary and lifestyle changes also may help
        control high blood pressure. About lifestyle, he should stop smoking completely.
        And about diet, he should be moderate in drinking and eating. Some people
        with mild hypertension can lower their blood pressure by reducing sodium
        in their diet. Does Mr. O think he takes in too much salt? If so, he needs
        to change his diet and eat less salt. Also, excessive alcohol intake (more
        than two ounces daily) raises blood pressure in some people and should
        be restricted. Blood pressure also returns to normal in many obese people
        when they lose weight. In fact, he has 20kg extra weight too! So, he should
        lose weight. Increasing physical activity can reduce blood pressure in
        some people too. I'd like to suggest that many obese people should do swimming
        as a method of exercise, because swimming is good exercise for the whole
        body and doesn't injure the knees or waist. And as a consequence, many
        people can reduce their weight without burden on bodies. 
        
        
        
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