Mitsumasa Nakayama writes:
1. The effective ways to inform Mr.O
can be several patterns in discussing his current risk factors. One of
the most effective ways is to tell him some information which relates to
several diseases. Before telling him, I want to consider the most important
factors that influence his case. I would list these as his risk factors
about coronary disease - his age, high blood pressure, cigarette smoking,
high blood cholesterol, physical inactivity, overweight, heredity, and
being a male, etc. So he has many, many problems. Some of them seem inevitable
such as his age, sex and heredity. And then, about his age, I can tell
him that 45 percent of all heart attacks occur in people under age 65.
It is based on the Framingham Heart Study. In addition to that, about 80
percent of coronary heart disease mortality in people under age 65 occurs
during the first attack and in 48 percent of men who died suddenly of coronary
heart disease, there were no previous symptoms of the disease. In this
way, I can give some information. I think the most risky factor is high
blood pressure, so I also will give him information about this.
2. Sudden death occurs at from four to six times the rate of the general population among people who've had a heart attack. He should know what do when a heart attack. I think that if he experiences one or more symptoms of a heart attack, he should act quickly and take the following steps. First, sit down or lie down. If symptoms persist for 2 minutes, he should call his local emergency telephone number and say he may be having a heart attack. He should leave the phone off the hook so that medical personnel can locate his address if he should become unconscious. Second, if he has nitroglycerin tablets, he needs to take up to three pills, one at time every 5 minutes. Third, 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 him than for him to start off for the hospital. If he can get to the hospital faster by car than by ambulance, have someone drive him. Do not drive himself-it could be dangerous. Fourth, do not delay getting medical treatment, even if he is not sure he is having a heart attack. A delay can cause permanent damage to his heart muscle or even death. Let the doctor determine whether or not he is having a heart attack. If his breathing or pulse stops, any person who is trained in cardiopulmonary resuscitation (CPR) should immediately begin the procedure. Call his local emergency telephone number first.
3. Mr. O should relieve hypertension. His dietary and lifestyle changes may help control high blood pressure. Blood pressure also will be reduced if he loses weight. And increasing physical activity can reduce blood pressure. Before drugs are prescribed, these methods to control blood pressure are often recommended for Mr.O with only mildly elevated blood pressure. And he has to get a many knowledge of the heart attack such as medication. Because getting prompt treatment for a heart attack can be lifesaving. For instance, nitroglycerin is a drug that reduces the pain of angina by widening blood vessels to allow more blood to reach the heart muscle. People who have angina should have nitroglycerin with them at all times and should take it immediately if they feel pain in their chest. Besides, he should use drugs. The A.C.E inhibitors interfere with the body's production of angiotensin, a chemical that causes the arteries to constrict. The calcium antagonists can reduce the heart rate and relax blood vessels. Anymore, he should reduce his LDL and increase his HDL. Excess cholesterol and unsaturated fat collects in the linings of blood vessels, forming fatty deposits called plaques. Over time, blood vessels may become clogged, reducing the blood flow and oxygen supply to the heart muscle. Without sufficient oxygen to the heart, this may cause chest pain, angina, or if the blood supply is cut off, there is heart muscle injury and a heart attack, possibly resulting in sudden death. Clotting or blockage in the head or neck can result in a stroke.
4. In the long term if he thinks about it, he should change his life style mainly. He once had been a heavy smoker, but he has cut down his smoking from a pack a day to less than half a pack. But even if he cuts his cigarettes to half, this is still bad for his heart. Smoking relates to many illnesses. Nearly one-fifth of deaths from cardiovascular diseases are attributable to smoking. It is also estimated that about 37,000- 40,000 nonsmokers die each year from cardiovascular diseases as a result of exposure to environmental tobacco smoke. So, it would be better for he to decrease the amount of cigarette little by little. Another problem to prevent heart disease is the cholesterol (This problem is linked with short term improvement.) It is reported that among elderly Japanese-American men in the Honolulu Heart Program Fourth Examination (1991- 93), 42 percent had cholesterol levels greater than or equal to 200 mg/dL or were taking cholesterol-lowering medication. As he can see from this report, decreasing his cholesterol may be lead to preventing his possibility of another heart diseases. Cholesterol is a type of fat made by his liver and it is also contained in certain foods that he eats, such as eggs, meat and dairy products. When he eats these foods often, the amount of cholesterol in his blood is increased. Foods high in saturated fat can also raise the amount of cholesterol in his blood, because his liver turns saturated fat into cholesterol. Cholesterol travels through the blood in different types of packages called lipoproteins. The low density lipoprotein (LDL) delivers cholesterol to the body. The high density lipoprotein (HDL) removes cholesterol from the blood stream. It is important for him to reduce LDL and increase HDL. To reduce fat, trim away all visible fat and boil, bake, or broil rather than fry meats. He can reduce dairy products he takes. He can use margarine instead of butter. The third problem for him is that he is 20 kilos overweight (blood pressure returns to normal in many obese people when they lose it). It probably results from the fact that he hardly gets out of the office to do exercise. 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. To keep his weight down, he needs to participate in routine physical exercise and control his calorie intake. He should go to the hospital, have a his doctor check him regularly and take an examination when the occasion demands.
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