CARDIO HEART DISEASE

Cardio Heart Disease



Abstract

Heart Diseases and elder age both draw human beings close to the severity of coronary heart diseases. scientific data is lacking in this area since the large studies exclude seniors who are too old, because of the high risk of excessive mortality. In this paper we shall study a case of a patient Mary and prescribe a 10 weeks program. We evaluated a 66-year-old woman(Mary) with apolipoprotein (apo) A-I deficiency, high levels of low-density lipoprotein (LDL)-cholesterol, hypertension and impaired glucose tolerance. The patient had corneal dullness, but neither xanthomas, xanthelasma, nor tonsillar hypertrophy. She was not symptomatic for coronary heart disease (CHD), and had normal electrocardiograms at rest and exercise using a cycle ergometer. This patient is the oldest among those with apo A-I shortage reported in the literature, and she had no symptoms of CHD despite the accumulated risk for the disease.

Cardio Heart Disease

Introduction

The high prevalence of cardiac complications in this population and their multiple facets attest to the interest in this topic. As is often the case, scientific data is lacking in this area since the large studies exclude seniors who are too old, because of the high risk of excessive mortality. However, all clinicians can testify to the questions generated by the suspicion or the onset of a cardiac complication in this type of patient.

Patient Information

Patient details

Mary Age-66

Cardiac Status

Current status Rest BP 148/90 mmHg Rest HR 58 bpm reg

ACS/MI:Inferior - date 9/8/08

Current Medication

aspirin, beta blocker, ce inhibition, statin

Investigations

ETT: Yes Date 25/8/08 Angiogram: Yes LV Function:

Result: +ve ST decrease 2mm at 5mins 30secs Date: 26/8/08 Moderate

Protocol: Full Result: RCA occluded proximally-filled by collaterals

CHD Risk Factors

Family History, Hypertension, BMI-28

Past Medical History: Hypertension

Other Considerations: Hiatus Hernia. Degenerative Spine

Date of entry to phase 3: 27/9/08

date of discharge from phase 3: 22/11/08

No of ex sessions attended: 10

Pre-ex HR reg: 58bpm

Pre-ex BP: 146/85mmHg

Training HR: 100-106bpm RPE @ 11-12

Total CV time in Phase 3 prescrition 18 mins

Competent in self pacing exercise: Yes

Limitations during exercise: No

Adaptations to exercise: No

Walk Time: 1 hour

Freq of walks per week: 2

Resumed work: Retired

Patient Goals for activity & any associated CHD risk factors

to keep BMI down-aim for 25

to increase physical activity-aim for RPT 13, daily 30min walk

to have BP checked and keep below 140/85.

Is it reasonable to screen for coronary heart disease? Should investigations be pushed further? Does an aggressive treatment carry the risk of being more dangerous than effective? These are some of the questions that cardiogists encounter daily. The responses that will be advanced herein should be based on data from the literature, unfortunately often disappointing, and on collaboration with experienced and commonsensical cardiologists.

1. Epidemiology of the cardiac manifestations in elderly hearts

Few studies are available other than the study, which investigated 10,000 heart subjects randomly selected among those eligible for insurance system. More than half of the hearts were over the age of 65 years and nearly 25% were older than 75.

Within the total heart population, 17% presented a coronary heart disease (CHD) documented by angina, myocardial infarction (MI), or a ...