Low-risk Cardiac Patient
Case Study
Andrew Gerhard, H.BSc(Kin),C.K.
Cardiac Rehabilitation Centre
Hôpital régional de Sudbury Regional Hospital
Basic Demographics
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Mr. Homer Simpson
41 year old male
Married, 3 children
Employed at power
plant
• Leisure activities
include bowling,
watching TV
Medical History
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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
Coronary Risk Factors
Modifiable
DYSLIPIDEMIA
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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
Coronary Risk Factors
Modifiable
Overweight
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Ht: 5’9”
Wt: 255 lb.
BMI: 39
Waist/hip ratio: 1.4
Coronary Risk Factors
Modifiable
PSYCHOLOGICAL ISSUES / STRESS
• no drug plan
• financial stress
• employer not
co-operative in
providing modified
return to work
Coronary Risk Factors
Nonmodifiable
FAMILY HISTORY
• Homer’s brother died
at age 51 from a MI
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 ankle
bilateral B/K TED stockings
Medications
• Pravachol - 40 mg OD
• Metoprolol - 50 mg BID
• EC ASA - 325 mg OD
Functional Capacity
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Routine stress test post CABG
Completed Stage IV Bruce Protocol
12.5 METS (4.2 mph, 16% grade)
Non-ischemic
Risk Stratification
• Risk of Disease Progression: 2.6
• Risk of Acute Event: 0
• Total score: 2.6
Risk Factor Management
Obesity and Dyslipidemia
Diet:
• Follow Canada’s Food Guide or AHA
Step 1 diet
• Set reasonable weight goal
• Emphasize positive
results from small
weight loss
Risk Factor Management
Obesity and Dyslipidemia
Exercise:
• Expect compliance issues
• Provide frequent initial support
• Set specific goals / rewards
• Encourage social
support
Risk Factor Management
Obesity and Dyslipidemia
Exercise: FITT principle
F - 3 to 5 times a week
I - HR 30 beats above resting
T - From 15 minutes a day initial
to 40 minutes per day after 3 months
T - Walking or cycling
Risk Factor Management
Stress Management
Medication Expenses
• Explore less costly medication
substitutions
• Ask physician for sample medications
• Explore “Trillium Foundation”
Risk Factor Management
Stress Management
Vocational Issues
• Can safely sustain work < 50% of max
MET level (< than 6 METS)
• Corresponds to medium work
level (up to 50lb handled
on occasional basis)
• Need to have PDA of job
Risk Factor Management
Stress Management
Vocational Issues
• Fear plays biggest factor
• Employer not required to modify job
• Get help from OH&S
department, LTD provider