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
--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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