Preventing Heart Attacks in Patients at Risk "Graham a 52-year-old executive "

Case study ( 5471 views as of October 21, 2017 )

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:
44

Conversation based on: Preventing Heart Attacks in Patients at Risk "Graham a 52-year-old executive "

Preventing Heart Attacks in Patients at Risk "Graham a 52-year-old executive "

  • Graham needs to adjust his lifestyle if he wants his blood pressure and cholesterol levels to improve. Diet and exercise will benefit him the most, and an exercise routine should be administered as soon as possible. Because of the exercise-induced hypertension, his heart rate should always be monitored during exercise - at the same time, Graham should begin on a walk/jog program until his conditioning levels adapt to the physical activity.
    Flag as inappropriate
    • Walking groups are becoming very common. Not only for the exercise factor but for the socialization as well
      Flag as inappropriate
    • Good comments I agree with your take on checking his blood pressure. Walking is a great way to build up both your strength and cardiovascular strength. Having someone like a personal trainer work with Graham is crucial.
      Flag as inappropriate
  • So in addition to medications, a critical aspect of treating patients after a heart attack is changes towards a more healthy lifestyle. And what healthy lifestyle choices do is both a direct effect on the heart, as well as an indirect effect to the heart. A very large trial demonstrated that 90 percent of all heart attacks can be predicted by nine modifiable risk factors, which can be positively influenced by changes in one's lifestyle.
    Flag as inappropriate
    • The procedure itself takes about an hour. It’s done in a local anesthetic but in a sterile operating room, or a cardiac [inaudible] suite done under sterile technique.
      Flag as inappropriate
    • @K.Michael - I believe the 9 modifiable risk factors for cardiovascular disease are smoking, obesity, alcohol consumption, physical activity level, high blood pressure, diabetes, high cholesterol, fruit/vegetable intake, and psychosocial factors.
      Flag as inappropriate
    • Where would you find a list of these heart attack markers?
      Flag as inappropriate
    • What were the 9 modifiable risk factors identified ?
      Flag as inappropriate
  • Also, marketers are so skilled at making food seem healthy. When really, it's full of sugar or non-real food. Being healthy means eating more food from scratch, and fewer processed foods.
    Flag as inappropriate
    • This is so true. One easy way to improve your eating is to just start to eat real foods. Cooking doesn't have to be difficult
      Flag as inappropriate
  • Does taking a "baby aspirin" a day really ward of a heart attack ? Who should be doing this ? At what age ? Based on older family members the reason to take it varies and can be confusing.
    Flag as inappropriate
    • Aspirin acts as a blood thinner, so in this context it would prevent blood clots that can cause heart complications. Low-dose aspirin is often recommended to those at high risk of heart attack for this reason.
      Flag as inappropriate
    • My mother was told to be taking this every day. Although they now call it low-dose aspirin since it's not to be given to babies or children anymore!
      Flag as inappropriate
    • Why baby aspirin? What is in it to help prevent heart attacks?
      Flag as inappropriate
  • He really needs to learn to eat more fruits and vegetables to help develop a healthy heart. A nutritionist could help him find tasty ways to add them to his diet.
    Flag as inappropriate
    • Eating fruits and vegetables will help not just his heart, but almost every aspect of his life.
      Flag as inappropriate
  • Heathy eating habits and exercise can have a hugely positive impact on one's health. Now is the time to pull out all the stops and act!
    Flag as inappropriate
    • Healthy eating is a daily activity that starts with a good exercise program. If you combine the two you also get a very positive mental bump from endorphins and the accomplishment of doing something for yourself.
      Flag as inappropriate
    • Being active and knowing what goings into your mouth is a great start is managing your health. People should seek help if they are unsure on how to maintain a healthy lifestyle.
      Flag as inappropriate
  • My mother is told to take "baby aspirin" to help with her cardiovascular risks. What's the current studies and recommendations on taking low dose aspirin daily?
    Flag as inappropriate
    • Agreed, I am definitely interested in knowing more about current recommendations for baby aspirin and heart attack risks. When I was pregnant with my son, I was hypertensive and was told to try baby aspirin until 32 weeks. He came early so my body didn't have enough time to clear out the baby aspirin. I had trouble with bleeding at my epidural site after they removed the needle. So for anyone taking baby aspirin, please do remind them that they will clot slower and to be careful with cuts and injuries.
      Flag as inappropriate
    • My Father in Law is in the hospital right now with congenital heart failure (fluid on the heart). He thought it was a heart attack and took doses of nitroglycerine. Is this something that can "ward off" a heart attach? How effective is it?
      Flag as inappropriate
    • @yuan, great question. This intervention has been around for a long time and I'd also be interested to know of if there are more current studies on low does aspirin and heart attacks.
      Flag as inappropriate
  • Dieticians and nutritionists can really help identify where those sources of saturated fat are hidden. They are sneaky fats and are in things you would not expect.
    Flag as inappropriate
    • Spending time with a nutritionist is more than just getting a meal plan. It's all about learning what is in packaged foods and learning about what to look for and what to avoid.
      Flag as inappropriate
    • There are many dietary aspects that can be looked at when focusing on heart health and preventing heart attacks. Cholesterol is one aspect but reducing simple sugars and foods that have trans fats are important too. Dietitians are a great resource for people that are concerned with heart health.
      Flag as inappropriate
    • This is very true. The more we move away from a diet of "real" food the more hidden fats there are
      Flag as inappropriate
    • This is very true. The more we move away from a diet of "real" food the more hidden fats there are
      Flag as inappropriate
  • I don't think he should place too much on a normal treadmill test as the test was stopped due to a spike in blood pressure. He should work with the healthy heart program he was referred to get his condition under control
    Flag as inappropriate
    • This is an interesting point. During a treadmill test the person observing saw that my father in law was breathing heavy. They reduced the intensity and told him to keep walking. When the test was done he waited for the results only to find out he had to do the test again. The doctor was concerned that he was not "pushing" himself enough during the test. He explained what happened and the next time the doctor was present for the test. He is now on medication and being monitored. We need to ensure when we are sent for tests we question why things are being done and not rely on what we are being told.
      Flag as inappropriate
  • Heart healthy strategies is advisable for most people as some individuals may not have all the risk factors and may still get a heart attack.
    Flag as inappropriate
    • Yes a lot of time these healthy heart programs are put in place when it's almost too late for the individual.
      Flag as inappropriate
    • @Mr. Jackson Sayers - this is so very true. My father has had a few heart attacks and a quad bypass. He still doesn't see the correlation between his diet and his issues
      Flag as inappropriate
  • I don't believe it is ever unsafe to exercise but given this gentleman's overall health he would benefit from a trainer or coach to reduce the stress on his heart
    Flag as inappropriate
    • @Kimberley, the Healthy Heart program will help this gentleman. It has stages of exercise clearance that the exercise specialists follow to ensure there isn't any risk to the patient's health, and that they are exercising safely. The initial stages as well are offered in a hospital setting so the appropriate medical personnel and equipment are on-site to deal with any emergencies.
      Flag as inappropriate
  • I think referring this gentleman to a wellness coach could also help guide him through this process. It sounds as though he has a lot of lifestyle habits that need changing to reduce his heart risk, and it is often overwhelming for people to make these changes. By working with a coach, he may have greater success in his efforts.
    Flag as inappropriate
    • He has already stopped smoking so a wellness coach should have good success in helping him make other changes that will help prevent heart attacks.
      Flag as inappropriate
    • @Michelle Kaarto - a wellness or life coach to assist this gentleman in making all of the necessary changes
      Flag as inappropriate
  • Mt Father died of a Heart Attack and I wish we had know about Saturated fats in his diet as he bacon every morning of his life.
    Flag as inappropriate
    • We had a family friend who worked in a sausage factory for years and he died with multiple artery blockages.
      Flag as inappropriate
    • @Carrie yes, I had the same question. When the information about preventing heart attacks or being healthy changes it is difficult to keep up.
      Flag as inappropriate
    • Aren't studies showing that the saturated fats in natural meats aren't as evil as they had predicted? I know there was a lot of demonizing of eggs for increasing cholesterol, but now they talk about how healthy they are in moderation. I am starting to think it isn't the "natural" fats but the sugars, and the carbs, and the processed foods and fats that contribute to high cholesterol and heart attack.
      Flag as inappropriate
    • @kimberley, it can be true that older people are more reluctant to make changes, even when talking about preventing heart attacks, but speaking with a health professional specialized in diet, like a Nutritionist or Naturopath, can help people figure out changes that would work best for them. Changes that are easy to make with the most health benefits.
      Flag as inappropriate
    • I find that many older people are reluctant to make dietary changes and eat healthier
      Flag as inappropriate