Kunihiko Umekita writes:
1) What would be the most effective
ways to inform Mr. O of his current health?
Coronary disease risk factors are cigarette smoke, cholesterol, physical inactivity, overweight and diabetes. You (Mr.O) have many risk factors. You had once been a heavy cigarette smoker, but you have cut down your smoking from a pack a day to less than half a pack. It's O.K. But you must stop smoking now, because, in 1990 about 417000 Americans died of smoking-related illnesses. Nearly one-fifth of deaths from cardiovascular diseases are attributable to smoking. Smoking-related illnesses cost about 50 billion dollars annually in medical care. And the result of your cholesterol tests are not positive: LDL -- 173 mg/dl; HDL -- 26 mg/dl. LDL is one factor of CHD and CVD. The result indicates your LDL level is a high risk. Your blood pressure indicates moderate to high hypertension, 165-105 mm Hg. In addition your only exercise is walking across the street from your apartment to your office and back.
Also, Mr. O is almost 20 kilos overweight.
So, Mr.O must consider his every food and reduce these risk factor effects
(for example, do exercise, stop smoking, eat food contain HDL etc.)
2) Because Mr. O delayed seeing a doctor when he suffered his first heart attack, you will want to help him prepare for the right kind of behavior in the event he should have another heart attack.
You must get help immediately. You must get to prompt treatment for heart attack. So you can save your life. You should take the following actions. a) Sit down or lie down. b) If symptoms persist for 2 minutes, call your local emergency telephone number and you should say that you are having a heart attack. Leave the phone off the hook so that medical personnel can locate your address if you should become unconscious. c) If you have nitroglycerin tablets, you should take up to three pills, one at a time every 5 minutes. d) 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. e) When we can get to the hospital faster by car than by ambulance, have someone drive you. f) When you arrive at the emergency room, you should announce clearly that you may be having a heart attack.
3) What should Mr. O do within the next few weeks to improve his health outlook?
a) Mr. O needs to see a doctor and follow his doctor's instructions. He should stay on medication. O's dietary and lifestyle changes also may help control high blood pressure. For example reducing sodium in his diet.
b) If he loses weight, blood pressure
also returns to normal. 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.
If Okada can not take these methods of control, I'll give him medication. For instance, antihypertensives are available to lower high blood pressure. Some, called diuretics, rid the body of excess fluids and salt (sodium). Others, called beta blockers, reduce the heart rate and the heart's output of blood. Another class of antihypertensives is called sympathetic nerve inhibitors.
Sympathetic nerves go from the brain to all parts of the body, including the arteries. They can cause the arteries to constrict or narrow, thereby raising blood pressure. This class of drugs reduces blood pressure by inhibiting these nerves from constricting blood vessels.
c) Reducing cholesterol levels in the blood and fat in the diet can prevent heart disease and related deaths. So, I will take blood cholesterol tests. This tests measure the amount of high-density lipoproteins and low-density lipoproteins present in the blood."high cholesterol" level means an excess of LDL in blood.
Less than 130 mg/dL = Good or desirable level;
130 to 159 mg/dL = Borderline or high risk;
160 mg/dL or above = High risk.
The lower the HDL level the greater the risk for heart disease. Any HDL-cholesterol level lower than 35 mg/dL is considered low. Quitting smoking, losing weight (Mr.O is overweight), and becoming physically active may help raise O's HDL-cholesterol level.
Next, I will consider the result of blood cholesterol tests, and determine a medical plan (medication, ergotherapy etc.) and suggest what would be best.
4) What should he do in the longer term to help prevent the occurrence of another heart attack?
In the long term, you should change your life style. I heard that you once had been a heavy cigarette smoker, but you have cut down your smoking from a pack a day to less than half a pack. But even if you cut your cigarettes to half, it is still bad for your heart. Smoking relates to many illnesses. It is reported that nearly one-fifth of deaths from cardiovascular diseases are attributable to smoking. So, it would be better for you to decrease the amount of cigarettes little by little.
Another problem for you to prevent heart disease is cholesterol. 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 you can see from this report, decreasing your cholesterol may lead to preventing your possibility of another heart diseases. Cholesterol is a type of fat made by your liver and it is also contained in certain foods that you eat, such as eggs, meat and dairy products. When you eat these foods often, the amount of cholesterol in your blood is increased. Foods high in saturated fat can also raise the amount of cholesterol in your blood, because your 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 you to reduce LDL and increase HDL. To reduce fat, trim away all visible fat and boil, bake, or broil rather than fry meats. You can reduce dairy products you take. You can use margarines instead of butter. It would be good for you to eat egg yolks only three times a week.
The third problem for you is that you are 20 kilos overweight. This probably results from the fact that you hardly get out of the office to do exercise. People with lower incomes and less than a 12th grade education are more likely to be sedentary. 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 your weight down, participate in routine physical exercise and control your calorie intake.
Finally you should consider how your risk factors effect your current health. Go to the hospital and take examinations regularly. I hope I will see you then! This is the most important point.
| Click the BACK button to return to the student index.|