Question

You were the physician on call when he was brought in. Complete a medical history on this patient and answer his wife’s questions.

1.	List Rob’s five primary risk factors for heart disease given in the scenario.
2.	List Rob’s two secondary risk factors for heart disease.
3.	What three or four lifestyle changes will you tell Rob to make to reduce his heart disease risk?

Rob’s wife has read the chart. She is distraught and has several questions for you. Please respond.

4.	“Doctor, I really don’t understand some of the words used on the chart. What is angina? Myocardial infarction?What is atherosclerosis, and will it ever go away?”
5.	“I saw that his cholesterol was 280, his HDL level was 28, and his LDL level was 174. His cholesterol and HDL ratio was 10, and his triglycerides were 325. What do each of these mean? What is normal or desirable for each?”

	a.
	b.
	c.
	d.
	e.

6.	“Rob doesn’t want to quit smoking—he’s smoked for 20 years. Why is smoking bad for his heart?”
7.	“A nurse said Rob needs a special exercise program to aid in recovery. Won’t exercise strain his heart? What good will it do?” (Give three benefits.)
8.	“Rob enjoys having an occasional glass of wine. Will he have to give this up?” How much alcohol will he be allowed, if he wishes to consume it? What about his wife, what is the recommendation for women and alcohol consumption?
Now that you have the knowledge to answer Rob’s wife’s questions, can you turn this knowledge inward? Use several sentences to explain your answer.

Answer 1

1. Primary risk factors of heart diseases:

• Age
• Gender : males are at a higher risk of heart diseases than females
• Family history of heart diseases
• Environmental pollution
• Race

2. Secondary risk factors for heart disease are smoking and high cholesterol levels

3. Lifestyle changes to reduce heart disease risk:

• Avoiding unhealthy diet and switching to healthy foid like green vegetables, dairy products
• Quiting smoking
• Incorporating daily walks and light exercises in his daily routine
• Avoiding fatty, oily, fried food

4. ANGINA : it refers to chest pain caused due to decreased blood supply to the heart. It is characterised by feeling heavy pressure on chest area or squeezing of chest. Its management includes medicines like beta blockers, calcium channel blockers and vasodilators. Lifestyle changes are recommended. In severe cases angioplasty is done.

MYOCARDIAL INFARCTION : it is commonly known as heart attack. The condition is characterised by reduced or absence of blood supply to the heart muscles resulting in severe damage to cardiac muscles. it may lead to heart failure. the common symptoms of myocardial infarction are chest pain radiating to arm, neck and jaw, nausea, dizziness, heart burn, shortness of breath. MI management included medications like. nitroglycerin, anticoagulants, fibrinolysis drugs. the medications need to be taken lifelong with lifestyle modifications. surgical interventions like pecutaneous coronary intervention may be needed sometimes.

ATHEROSCLEROSIS : atherosclerosis is the building up of plaque within the arteries leading to compete or partial blockage of the arteries. It may lead to coronary artery disease, stroke, peripheral artery diseases. the main cause of atherosclerosis include high cholesterol levels, smoking, sedentary lifestyle, unhealthy food habits, hypertension, diabetes, overweight. management includes drugs like antihypertensive, cholesterol lowering drugs, anticoagulants. surgical interventions include  percutaneous coronary intervention, coronary artery bypass graft, or carotid endarterectomy.

5. in an healthy individual normal cholesterol is less than 200mg/dl, HDL is 60mg/dl or more, LDL is less than 129mg/dl, cholesterol-to-HDL ratio 5:1, triglycerides 150mg/dl or less.

The test name is lipid profile and is done to check the amount of lipid levels in the body. HDL is the good cholesterol and LDL is bad cholesterol. high amount of cholesterol, LDL, triglycerides increase the risk of heart diseases.

6. smoking increases the risk of heart diseases. the nicotine present in the cigarettes leads to building up of plaque in the arteries and vasoconstriction. moreover carbon mono-oxide produced due to smoking reduces the binding capacity of Hg to O2. smoking also reduces lung functions. all this leads to increased risk for heart diseases.

7. Exercises will help Rob to lower blood pressure, cholesterol levels, maintain weight and strengthen the heart, improve blood flow and lung functions.

to avoid strain on heart start gradually. start initially with a 5-10 minutes of walk.

a proper warm up period before starting the exercise and cooling down at the end of session is necessary.

A 30 minutes exercise session for 5 days a week is sufficient.

Opt for aerobic activities. do not go for any strenous exercises like weight lifting.

avoid over exhaustion.

look out for any symptoms of over heating, chest pain, shortness of breath. stop immediately if any of these occur.

8. alcohol consumption within moderation do not cause harm to heart. alcohol consumption upto 2 drinks per day for men and 1 drink per day for women is considered safe.

Heart diseases is a broad term including myocardial infarction, coronary artery disease, heart failure.

Risk factorsfor heart diseases include age, gender, smoking, obesity, hgh bp, high cholesterol.

some of the risk factors are modifiable and canbe controlled through healthy diet, exercise, avoiding smoking.