Takashi Murahara writes:
Mr. O has the following risk factors
for another myocardial infarction:
(1) high hypertension, 165-105 mmHg (this level is classified as stage II hypertension);
(2) LDL -- 173 mm/dl; HDL -- 26 mm/dl;
(3) sharp chest pains that sometimes occur right after his dinner meals, a clear symptom of angina pectoris;
(4) 20 kilos overweight;
(5) having once been a heavy cigarette smoker, he has cut down his smoking from a pack a day to less than half a pack.
Hypertension is one of the main risk factors of CVD. Because of high blood pressure, the arterial wall was injured, which is a cause of atherosclerosis or thrombosis. Extra LDL in the blood adheres to the arterial wall and deposits of LDL are oxidized. Macrophages, which are scavengers in our body, uptakes oxidized LDL by choice, because oxidized LDL is recognized as foreign matter by macrophagea. Before long, macrophages are filled with oxidized LDL and collect on arterial wall, which is the early stage of atherosclerosis. Sharp chest pains, angina pectoris, are another clear symptom of CVD. He will sometimes feel pain in his left arm, because angina pains are projected on the left arm, related to dermatomes.
Also, being almost 20 kilos overweight
will be load on the heart. Cigarette smoke contains many bad agents for
CVD. Nicotine constricts blood vessels strongly. Carbon monoxide bonds
to hemoglobin and will cause ischemia in which some chemical agents injure
the vascular endothelium.
At first, I would recommend that he take some clinical tests such as electrocardiography (ECG) and angiography to know more about his cardiovascular condition.
Second, Mr.O had better use some vasodilator, which dilates blood vessels, like nitroglycerin. I suggest he undergo treatment for hypertension and hyperlipidemia. There are some antihypertensive agents, such as beta-blockers and angiotensin converting enzyme inhibitors. Estrogen reduces LDL level in blood. Aspirin also will be a prophylactic because it inhibits thrombogenesis.
He must alter his life style of course. I suggest three things as follows.
(1) He must eat low fat diets. He must eat many vegetables and fish. It is also necessary for him to reduce salt in his diet. Excessive intake of sodium keeps up hypertension.
(2) He must do moderate exercise everyday. I would like to urge him to walk. I also suggest that he walk with his family or friends and use a pedometer because he can enjoy walking and have a target like 10,000 steps a day.
(3) He must quit smoking, which helps to improve his hypertension and stop atherosclerogenesis.
So, a combination of lifestyle changes (1-3, above) and strict monitoring by his doctors, and regular check-ups and regular taking of medicines (described above) will help improve Mr. O's health outlook in the longer term. Finally, I would like to give Mr. O one more piece of advice. He should consult his doctor immediately when he feels a bad condition in his body. The sooner he consults his doctor, the better his doctor can treat him.
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