Low-risk Cardiac Patient Case Study

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Low-risk Cardiac PatientCase Study
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Basic Demographics

• Mr. Homer Simpson
• 41 year old male
• Married, 3 children
• Employed at power plant
• Leisure activities include bowling, watching TV

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Medical History

• 5-year history of angina on exertion
• Angina unstable over last 2½ years
• Positive stress test result
• Angiogram severe triple vessel disease
• Grade 1 ventricle, 65 ejection fraction
• CABG X5 three weeks ago

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Coronary Risk FactorsModifiable

• DYSLIPIDEMIA
• On Pravachol with good control
• Total Chol 3.63 mmol/l
• LDL Chol 1.99 mmol/l
• HDL Chol 1.29 mmol/l
• TC/HDL 2.81
• Triglycerides 0.78 mmol/l

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Coronary Risk FactorsModifiable

• Overweight
• Ht 59
• Wt 255 lb.
• BMI 39
• Waist/hip ratio 1.4

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Coronary Risk FactorsModifiable

• PSYCHOLOGICAL ISSUES / STRESS
• no drug plan
• financial stress
• employer notco-operative inproviding
  modifiedreturn to work

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Coronary Risk FactorsNonmodifiable

• FAMILY HISTORY
• Homers brother diedat age 51 from a MI

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Clinical Examination

• Pulse 80/min and regular
• Bp 128/80
• Chest and left leg incisions clean, dry and
  intact
• A / E clear bilaterally
• Mild edema to left anklebilateral B/K TED
  stockings

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Medications

• Pravachol - 40 mg OD
• Metoprolol - 50 mg BID
• EC ASA - 325 mg OD

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Functional Capacity

• Routine stress test post CABG
• Completed Stage IV Bruce Protocol
• 12.5 METS (4.2 mph, 16 grade)
• Non-ischemic

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Risk Stratification

• Risk of Disease Progression 2.6
• Risk of Acute Event 0
• Total score 2.6

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Risk Factor ManagementObesity and Dyslipidemia

• Diet
• Follow Canadas Food Guide or AHA Step 1 diet
• Set reasonable weight goal
• Emphasize positiveresults from smallweight loss

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Risk Factor ManagementObesity and Dyslipidemia

• Exercise
• Expect compliance issues
• Provide frequent initial support
• Set specific goals / rewards
• Encourage socialsupport

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Risk Factor ManagementObesity and Dyslipidemia

• Exercise FITT principle
• - 3 to 5 times a week
• - HR 30 beats above resting
• - From 15 minutes a day initial to 40 minutes
  per day after 3 months
• - Walking or cycling

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Risk Factor ManagementStress Management

• Medication Expenses
• Explore less costly medication substitutions
• Ask physician for sample medications
• Explore Trillium Foundation

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Risk Factor ManagementStress Management

• Vocational Issues
• Can safely sustain work lt 50 of max MET level (lt
  than 6 METS)
• Corresponds to medium worklevel (up to 50lb
  handledon occasional basis)
• Need to have PDA of job

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Risk Factor ManagementStress Management

• Vocational Issues
• Fear plays biggest factor
• Employer not required to modify job
• Get help from OHS department, LTD provider