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Heart Care for Life
Developing the Program That Works Best for You
By Barry L. Zaret Genell J. Subak-Sharpe Yale University Press
Copyright © 2006 Barry L. Zaret and Genell J. Subak-Sharpe
All right reserved. ISBN: 978-0-300-12259-6
Introduction
Virtually all heart patients go through a process of trial and error to find a long-term program that fits their lifestyle while providing optimal treatment. They also experience occasional lapses and setbacks. In this book, we describe composite illustrative cases and situations culled from the long-term experience of treating patients. These particular cases highlight issues relating to cardiac care.
Stanley, for example, is a fifty-five-year-old executive whose work requires twelve-hour days and extensive, almost weekly travel. On one of these trips away from home he suffered a small heart attack, and later he had coronary artery bypass surgery. Beyond his hectic work schedule, a number of lifestyle factors worked against his heart health. Perhaps most significantly, he was some fifty pounds overweight. Although he had been an athlete in college, he had long since stopped exercising, citing his arthritic knees and work schedule as excuses. In Chapter 4, you'll learn how he and his doctor worked out a program that allowed him to modify his behavior while still retaining the activities that were important to him and his family.
Alice, a forty-five-year-oldpart-time school aide, is obese and has type II diabetes, which she treats with oral medication. A routine medical test found high blood cholesterol levels, but rather than take more medication, she elected to try dieting and increasing her exercise. She thought she was making progress until she was suddenly hospitalized after suffering a major heart attack. Her outcome and treatment are described in Chapter 3.
Jennifer's story is very different from Alice's. This trim, healthy-looking fifty-year-old woman has been a long-distance runner since her teenage years, and running is a very important part of her life. She exercises daily, runs one or two marathons a year, and frequently competes in half marathons and 10K events. She had never been aware of any cardiovascular problem, although both parents had heart disease when in their sixties and her brother, only a few years her senior, recently underwent coronary bypass surgery. The first indication that she, too, may have heart disease came after a long run when she developed mild, somewhat atypical, chest discomfort. She finally consulted a doctor when the chest pains become more frequent and intense. Tests showed she had serious coronary artery disease. (Her treatment and long-term program are described in Chapter 2.)
Sam is a fifty-two-year-old school bus driver who smokes two packs of cigarettes a day. He is moderately obese, and does not engage in any physical exercise. His first indication of a possible heart problem came when he developed shortness of breath and a feeling of mild pressure in his chest while walking up a flight of stairs at his home. Because his job involved the safety of dozens of children, his wife insisted that he see a doctor-who diagnosed high blood pressure, mild diabetes, and elevated blood cholesterol and prescribed medications to help with these problems. A more difficult but critical part of Sam's behavior modification program was a requirement that he stop smoking. How he managed to do this and alter other harmful health habits is described in Chapter 5.
John is an eighty-five-year-old retiree who winters in Florida and returns to New England for the spring and summer months. He golfs three times a week, and until recently, generally enjoyed good health. He has longstanding hypertension, which he keeps under control with medication. He also has moderately elevated cholesterol levels, for which he now takes medication. In recent months, he has experienced chest pain whenever he engages in physical activity, even something as moderate as golf. His doctor ordered an exercise stress test, which was markedly abnormal. At Sam's advanced age, should he consider invasive procedures, such as coronary angiography, stenting, or even coronary bypass surgery? (The outcome of his case is described in Chapter 10.)
Although each of these patients likely suffers from the same basic condition of cardiovascular disease, they must be treated as individuals. A forty-five-year-old obese woman with diabetes would be approached quite differently from a fifty-year-old active runner. A program of lifestyle modification for a hard-driving executive must consider his or her business schedule, physical limitations, and overall personality. The approach to symptoms in an individual responsible for driving children to school every day must be far more aggressive than that given to symptoms in an eighty-five-year-old retiree. Still, being eighty-five or even older does not exclude someone as a candidate for surgery or other invasive procedures.
Chapter 1 introduces the concepts of constants-the core medical values that doctors use to gauge the nature and severity of disease-and variables, the individual characteristics that set you apart from other patients with the same disease. Both must be considered in structuring a lifelong treatment program that works best for you.
The four chapters in Part I deal with lifestyle and heart health; specific topics include exercise, diet, stress and other psychological factors, and smoking. Part II provides a broad overview of the basics of lifelong treatment: diagnostic tests and procedures; medical treatment, surgery, and other interventions; and the role of alternative and complementary therapies.
The six chapters in Part III discuss the needs of different population groups: women, the elderly, minorities, young athletes, adults with congenital heart disease, and travelers with heart disease. The concluding Part IV describes recent advances in and research on promising future therapies; experimental treatments and clinical trials are also discussed.
Throughout this book, you'll find practical advice on how to make small lifestyle changes that can make a big difference in living with cardiovascular disease. You'll also gain insight into the process doctors use in fashioning a long-term program that works best for you. A final word of caution, however: although this book is based on years of experience in treating heart patients as well as the latest scientific advances, you should not use the information to alter your doctor's prescribed regimen. Instead, the information presented here is intended to broaden your understanding of the nature of heart disease, its causes, potential for prevention, and approaches to treatment.
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Excerpted from Heart Care for Life by Barry L. Zaret Genell J. Subak-Sharpe Copyright © 2006 by Barry L. Zaret and Genell J. Subak-Sharpe. Excerpted by permission.
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