Shinichiro Teranishi writes:
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 causal observation it is clear that Mr. O is almost 20 kilos overweight.
First of all, Mr. O must realize the serious condition he is in now. Mr. O complains of sharp chest pains, which is a clear symptom of angina pectoris. Mr. O's elder brother died of heart disease five years ago, which means he has quite a big chance of developing heart disease. Mr. O needs to start paying attention to his own health right now, otherwise he will get a fatal heart disease and could die of it. I think it is time for Mr. O to be conscious of having many risk factors of heart disease. Mr. O is no longer so healthy or so young as he thinks.
First, Mr. O has suffered a mild heart attack and now has angina. Angina--a feeling of pain, heaviness, tightness, burning, or squeezing in your chest--is an indication that a person has heart disease and is at risk of having a heart attack. Angina 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. Angina usually occurs during physical exertion or emotional stress. Mr. O had better talk about his heart attack with his doctor immediately and discuss if he had had any symptoms of angina, which are similar to those of an actual heart attack. Prompt treatment for angina can prevent him from having a heart attack. Many people experience angina for years, but do not seek treatment and eventually have a heart attack.
Additionally, Mr. O's blood pressure is very high. Because medical science doesn't understand the causes of most cases of high blood pressure, it's hard to say how to prevent it perfectly. Still, several factors may contribute to it. For example, obesity, sodium (salt), age and heredity are factors increase the chance that a person will develop high blood pressure. Being overweight or using excessive salt are two avoidable factors. Age is one risk factor that can't be changed. Generally speaking, the older people get, the more likely they are to develop high blood pressure. Heredity is another factor. People whose parents have high blood pressure are more likely to develop it than those whose parents don't. Other related factors contribute to high blood pressure is sedentary or inactive lifestyle. 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. Mr. O says 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. I can say that physical inactivity is a risk factor for him, too.
Another important issue for Mr. O's prognosis is to change his blood cholesterol count, that is, to reduce his LDL and increase his HDL. It is highly possible that his high blood cholesterol level increases risk of coronary heart diseases or other adult diseases. He should avoid eating high cholesterol foods such as eggs, cheese, and fatty meats as much as he can. Animal fats include cholesterol and much saturated fatty acids, and saturated fatty acids lead to high blood cholesterol. Mr. O should recognize that his blood cholesterol level is abnormal now.
I think Mr. O had no previous guidance on preventing heart disease. So, I will advise him about what to do for preventing the occurrence of another heart attack. And, I will show Mr. O general guidelines to improve his health outlook. Mr. O had better carry out the following improvements at once.
1) I encourage Mr. O to stop smoking. As people age, the walls of their arteries gradually thicken, and some study shows that cigarette smoking accelerates the process by more than a decade. By adding the equivalent of 10 years of aging to his arteries, the smoker is increasing his risk of stroke and heart attack.
2) I encourage Mr. O to eat more high-fiber foods such as whole grain cereals, legumes, vegetables, and fruits and low-in-cholesterol foods such as chicken, fish, and tofu. (This is Japanese traditional food. Tofu is made from soybean. So it contains high protein and low cholesterol.) He should try these foods, because taking fiber-rich foods and cutting down on total fat intake reduces your cholesterol level, and moreover lowers your blood pressure.
3) I recommend that Mr. O reduce the intake of sodium. Some people with mild hypertension can lower their blood pressure by reducing sodium in their diet.
4) I would highly recommend Mr. O maintain a healthy weight. Blood pressure also returns to normal in many obese people when they lose weight. The weight that's right for him is almost 20 kilos under his weight in the present state. Excess body fat increases his chances for high blood pressure, heart disease, stroke, and other illnesses. A registered dietitian can help him develop sensible eating habits for successful weight management. Regular exercise is also important to maintaining a healthy weight. In addition, I recommend Mr. O do fast walking for about 30-60 minutes. I think fast walking is one of the better ways for maintaining our good health. Because exercising burns body fats and cholesterol level lower.
Dietary and lifestyle changes may help control high blood pressure. But Mr. O has to remember that if he carries out these improvement, the changing in his body does not take effect soon. It takes a lot of time to change the condition in his body. Mr. O must try to continue to stop smoking, take healthy foods, have a good exercise and so on. In short, these improvements need a long time to work. The most important thing is for Mr. O to keep the guidelines in the long term for preventing heart disease.
When I prescribe drugs, I must pay attention to the following. Many medications known as antihypertensives are available to lower high blood pressure. In most cases, drugs to lower blood pressure is effective. But quite often people respond very differently to these medications. Thus most patients must go through a trial period to find out which medications are most effective while causing the fewest side effects.
Finally, I will tell Mr. O what he should do if he has the symptoms of a heart attack. This is because getting prompt treatment for a heart attack can be lifesaving. So, I advise Mr. O, if he experiences one or more symptoms of a heart attack, to act quickly and take the following steps:
1) Sit down or lie down.
2) 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.
3) If you have nitroglycerin tablets, take up to three pills, one at a time every 5 minutes.
4) 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.
5) 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.
6) Do not delay getting medical treatment, even if you are not sure you are having a heart attack. A delay can cause permanent damage to your heart muscle or even death. Let the doctor determine whether or not you are having a heart attack.
7) If your breathing or pulse stops, any person who is trained in cardiopulmonary resuscitation (CPR) should immediately begin the procedure. Call your local emergency telephone number first.
8) When you arrive at the emergency room, you or the person who brought you should announce clearly that you may be having a heart attack. Make sure you are seen at once.
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