Alcohol Moderate alcohol consumption helps protect against heart disease by raising HDL (good) cholesterol and reducing plaque accumulations in your arteries. Alcohol also has a mild anti-coagulating effect, keeping platelets from clumping together to form clots. On the other hand, drinking more than three drinks a day has a direct toxic effect on the heart. Heavy drinking, particularly over time, can damage the heart and lead to high blood pressure, alcoholic cardiomyopathy, congestive heart failure, and stroke. Heavy drinking puts more fat into the circulation in your body, raising your triglygeride level (Spence).
Risks for heart disease were lowest for the most frequent drinkers. For example, men who drank only one day a week had a 7% reduced risk, while men who drank daily had a 41% reduced risk (Medical News Today). Overweight Being an unhealthy weight, even if your cholesterol is under control and your blood pressure is normal, puts you at elevated risk for serious cardiovascular problems and/or diabetes. If you are obese, the risk is far greater than if overweight. Smoking Non-smoker; however, she should hold Jim to his promise to quit, since he is putting her at risk for respiratory infection, asthma, and/or lung cancer.
A person’s risk of heart disease and heart attack greatly increases with the number of cigarettes he or she smokes. Smokers continue to increase their risk of heart attack the longer they smoke. People who smoke a pack of cigarettes a day have more than twice the risk of heart attack than non-smokers. Jim is also putting his friends and family at risk with the second hand smoke. Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of respiratory infections, asthma, and cancer in humans (American Lung Association).
Exercise Regular physical activity helps prevent heart disease by increasing blood flow to your heart and strengthening your heart’s contractions so that your heart pumps more blood with less effort. Physical activity also helps you control your weight and can reduce your chances of developing other conditions that may put a strain on your heart, such as high blood pressure, high cholesterol and diabetes. It also reduces stress, which may also be a factor in heart disease (Mayo Clinic). Not mentioned in the first case study. Medication & Over-the-counter (OTC) drugs
Hormone replacement therapy (HRT) is used to supplement the body with either estrogen alone or estrogen and progesterone in combination during and after menopause. Estrogen and progesterone are hormones that are produced by a woman’s ovaries. When the ovaries no longer produce adequate amounts of these hormones, HRT can be given to supplement the body with adequate levels of estrogen and progesterone (Phillips). Blood pressure medication to lower his blood pressure. Aspirin, 50 to 325 milligrams once daily (75 to 325 milligrams for angina and previous heart attack) (U. S. Food and Drug Administration).
Diseases that Jim and Nancy are at risk for Diseases Jim Lung Cancer, COPD and/or Emphysema Since Jim is a smoker, he has a greater risk of developing lung cancer, chronic obstructive pulmonary disease (COPD), and/or emphysema. Since the lungs are for the exchange of air (mainly O2) into carbon dioxide (CO2). The bronchioles and the alveoli are not designed to handle smoke. With the irritation of smoke entering the lungs, lung cancer can start in the lining of the bronchi, trachea, or the alveoli. The most common type of lung cancer for smoker is non-small cell lung cancer (NSCLC).
This type of lung cancer accounts for 80 percent of all lung cancers. There are three types of NSCLC; however, the most common of those three is squamous cell carcinoma. This cancer begins in squamous cells within the digestive and respiratory tracts; once formed, this cancer generally grows and spreads slowly. Squamous cell carcinoma is linked to a history of smoking (Antigenics). If he stopped smoking, and over time, his lung function would increase; however, not know that amount of time he has been smoking for it is hard to give a timeframe on this.
COPD and emphysema are progressive diseases that make it hard to breathe and gets worse over time. Smoking is the leading cause of COPD and emphysema. Both diseases display some of the same symptoms: chronic, mild cough, shortness of breath, and fatigue. While COPD, displays other symptoms such as: wheezing; swelling of the ankles, feet, or legs; headaches, and frequent respiratory infections (Medline Plus). Jim should stop smoking and start deep breathing exercises (American Lung Association). Iatrogenic Diabetes or Type 2 Diabetes
The definition of iatrogenic diabetes is, “Diabetes mellitus brought on by administration of drugs such as corticosteroids, certain diuretics, or birth control pills” (Venes529). This disease is only applicable if Jim is taking thiszide-type diuretic and a beta-blocker (Rafael). If he is taking a thiszide-type diuretic and a beta-blocker, the diabetes that he could get is very similar to type-2 diabetes mellitus. With this, Jim would not have to take insuln shots; however, he would have to really start watching what he is eating. He should start on the Akins diet (high protien, fat and low carb) first.
This would help him loose weight; however, this could rise his triglycerides. With a rised triglyceride count, this could lead to a second heart attack. Once Jim and his doctor feel comfortable with the weight loose, Jim should ween himself of the Akins diet and start a new diet high in fiber, low in refined sugars and saturated fats. Coronary Artery Disease – Atherosclerosis Where Jim is overweight, and not knowing his full diet, he is at risk of coronary artery disease (CAD) or otherwise known as atherosclerosis. In the case study, Jim is at a cookout.
This would indicate that he had high fat foods such as cheeseburgers, hotdogs, chips, etc. If this high fat diet were the norm for him, he would have plague (fatty substances, cholesterol, cellular waste products, calcium and other substances) build up with in the inner lining of an artery of his heart. With Jim’s age, this build up of plaque could harden one of his arteries. However, let us assume that the atherosclerosis has not elevated to that level yet. The plaque can grow bulky enough to drastically reduce the blood’s passage through an artery, but most of the damage takes place when they become fragile and rupture.
Plaque that rupture will cause blood clots to form that can hinder blood flow or break off and travel to another part of the body. If either happens and blocks a blood vessel that feeds the heart, it causes a heart attack, in Jim’s case, a second. If it blocks a blood vessel that nourishes the brain, it causes a stroke, and if blood supply to the arms or legs is diminished, it can cause difficulty walking and ultimately lead to gangrene (American Heart Association). Jim’s high blood pressure and smoking also put him at risk.
Hypertensive Retinopathy With Jim having high blood pressure, he could be at severe risk of hypertensive retinopathy. High blood pressure is known to cause damage to blood vessels in the eyes. The higher the blood pressure and the longer it has been high, the more severe the damage is likely to be (Medline Plus). Jim is controlling his high blood pressure with medication and aspirin; however, without knowing how long Jim has had hypertension, it is hard what group he would fall into (group descriptions on the right). Disease Nancy Breast Cancer
According to the National Cancer Institute, Nancy’s age, alcohol consumption, hormone replacement therapy, and the fact that she is white, puts her at an extremely high risk for breast cancer (National Cancer Institute). In the uterus, the estrogen that stimulates the uterus to mature is then balanced by progesterone, which stops it. Unfortunately, the mechanism may not be so straightforward in the breast. Breast and uterus are two very different tissues and the breast does not shed its lining once a month. The liver, adrenal glands, and the breasts are secondary sources of estrogen (Mills).
Estrogen plays a major role in the development of breast cancer. Approximately 60% of premenopausal and 75% of postmenopausal patients have estrogen-dependent tumors. In estrogen-dependent breast tumors, estrogen stimulates the formation of growth factors that are essential for breast cancer growth. In cells, a protein called aromatase produces estrogen, and in breast cancer patients, tumors contain an abnormally high level of aromatase that generates a large amount of estrogen (Chen). With taking estrogen of seventeen years, the process probably has started. Coronary Artery Disease –
Atherosclerosis Where Nancy weighs more than she should, and not knowing her full diet, she is at risk of coronary artery disease (CAD) or otherwise known as atherosclerosis. In the case study, Nancy is at a cookout. This would indicate that she had high fat foods such as cheeseburgers, hotdogs, chips, etc. If this high fat diet were the norm for her, she would have plague (fatty substances, cholesterol, cellular waste products, calcium and other substances) build up with in the inner lining of an artery of her heart. With Nancy’s age, this build up of plaque could harden one of her arteries.
With her triglycerides and LDL (bad cholesterol) level above the normal ranges, it is safe to say that there is some plaque buildup within her heart. The plaque can grow bulky enough to drastically reduce the blood’s passage through an artery, but most of the damage takes place when they become fragile and rupture. Plaque that rupture will cause blood clots to form that can hinder blood flow or break off and travel to another part of the body. If either happens and blocks a blood vessel that feeds the heart, it causes a heart attack.
If it blocks a blood vessel that nourishes the brain, it causes a stroke, and if blood supply to the arms or legs is diminished, it can cause difficulty walking and ultimately lead to gangrene (American Heart Association). With Nancy’s high LDL and triglycerides, she is a walking heart attack waiting to happen. Respiratory Infection, Asthma, and/or Lung Cancer Since Jim is the smoker in the family, Nancy is at risk to. Secondhand smoke has been classified by the Environmental Protection Agency (EPA) as a known cause of respiratory infections, asthma, and cancer in humans (American Lung Association). Osteoporosis
With her sister diagnosed with osteoporosis and with her mother’s passing from complication following a broken hip, Nancy is most likely to get osteoporosis as well. Her age and hysterectomy will play a role in osteoporosis. In women, the sex hormone estrogen protects bones. If a woman goes through menopause early, the risk of osteoporosis increases. The same is true if the ovaries removed; that is because your ovaries produce most of the body’s estrogen. With having a hysterectomy, her body has lost the major source of her estrogen production; she is still making small amounts of estrogen through her liver, adrenal glands, and the breasts.
However, her body needs higher levels of estrogen to sustain healthy bones. The hormone replacement therapy that Nancy is on will help for a while; however, due to adverse effects of menopausal hormone therapy, such as increased risks of heart attack, stroke, blood clots in the veins, and breast cancer; menopausal hormone therapy is no longer recommended for long-term use in the therapy of osteoporosis (Crandall). For Jim, he should have two breathing tests done. The first test called spirometry would test his lung function.
With this test, it would measure how much air he can breathe in, and how fast he can breathe that air out. This is measured in two ways: peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1) (National Heart, Lung, and Blood Institute). Spirometry is done to look for diseases and conditions that influence how much air a person can breathe in, such as sarcoidosis or lung tissue scarring; furthermore, it is done to look for diseases that influence how swiftly a person can breathe out, like asthma and COPD.
The second lung function test that would be helpful is called a lung diffusion capacity test. This test measure how well oxygen passes from the lungs into the bloodstream. If this test came back with an abnormal result, it may indicate loss of lung tissue, emphysema (a type of COPD), severe scarring, or problems with blood flow through the body’s arteries (National Heart, Lung, and Blood Institute). Other information pertaining to his smoking habits, how long has he been smoking and how many cigarettes per-day, would be extremely useful to help diagnosis how much damage he has done to his lungs.