Case study ( 7163 views as of March 26, 2019 )
Graham, a 52-year-old executive with a history of well-controlled high blood pressure and “borderline” cholesterol levels, goes to see his family doctor as he is concerned about his potential to develop heart disease. He states that his father and grandfather both had heart attacks at around his age. Graham is fairly sedentary by his own admission and often eats out at restaurants to entertain clients. He considers himself a bit of a “Type A” individual and admits that he doesn’t deal with stress particularly well. He is not particularly fond of fruits or vegetables. He used to smoke but quit about one year ago. He is not on any medications and doesn’t like the idea of pills.
His exam shows a blood pressure of 150/90 mmHg with a heart rate of 80 bpm. He is overweight with a BMI of 29.
His family doctor arranges for an exercise treadmill exam, which is read as normal albeit with “marginal physical fitness”. The test is stopped because of exercise-induced hypertension (peak blood pressure 210/90 mmHg) and shortness of breath. There is no chest pain.
The patient is referred to the Healthy Heart program at the local hospital, where he is seen by a dietitian and an exercise physiologist. He is counselled on the need to adopt a “heart healthy” diet and to start a regular exercise program. He is also counselled on the harmful effects of stress on the cardiovascular system and referred to a cardiac psychologist through the Healthy Heart program. He may also benefit from doing yoga to reduce his stress levels .Author: Dr. Graham Wong, VGH