Question

Nancy

-feels tired all the time

-suffers from back pain and burning sensation in lower part of her chest

-Both do not watch what they eat and eat in abundance

-Nancy is possibly experiencing angina equivalent symptoms

Jim retired last year after 40 years in sales. He had suffered a massive heart attack a few years earlier and now takes medication to control his blood pressure as well as an aspirin every night. He is 68 years old, overweight, and keeps promising to quit smoking.

Nancy is 62 years old and just retired from teaching mathematics at the college level. Although she swims a few laps and lifts weights several times a week at the local Health and Wellness Center, Nancy weighs more than she should. She has been taking hormone (estrogen) replacement therapy since she had a hysterectomy at age 45. Now she's concerned about developing osteoporosis because her sister was recently diagnosed with it, and their mother died in early April from complications following a broken hip.

Nancy's test results (at rest and fasting levels):

TEST	NANCY'S RESULT	NORMAL RANGE
Heart rate	88 beats/min	60-100 beats/min
Blood pressure	138/85 mm Hg	90/60 - 140/90 mm Hg
Total cholesterol	238 mg/dL	<200 mg/dL
HDL	46 mg/dL	45-60 mg/dL
LDL	161 mg/dL	<100 mg/dL
Triglycerides	220 mg/dL	<150 mg/dL
Glucose	128 mg/dL	80-100 mg/dL

The weather was clear and the scenery was breath-taking as they walked and talked. Early one morning, after about 15 minutes of power walking on deck, Nancy started feeling nauseous and had trouble breathing.

"Let's stop and rest for a few minutes. Maybe that will help," he said. Jim helped her to a deck chair and fussed with a blanket to protect her from the cool morning air. Nancy's nausea decreased and her breathing improved. They sat on deck chairs for the next hour watching the whales swimming beside the ship.

The next morning during their power walking Nancy experienced a similar problem. "Jim, now I'm sure that something is wrong. For weeks I've been feeling tired and have had a nagging backache. But this nausea and shortness of breath are new. I'm scared. Do you think I could be having a heart attack?" she said.

"Nah, I doubt it. I mean, you don't have chest pains or anything like that, do you? Don't you remember how I thought one of those whales was sitting on my chest and wouldn't get up when I had mine?" said Jim.

"You're probably right. I don't have chest pains," she said. "Maybe it's just all the recent changes in my life and eating too much of this rich food."

As the group trotted down to the docks, Nancy pulled aside and Jim stayed to keep her company. Carol, a member of their group, slowed her pace, then went back to Nancy and Jim. "You two OK?" she asked.

"Yeah, I think so," replied Jim. "Nancy's been feeling pooped lately and has complained about a backache. Now she's having trouble keeping up with the group."

"Well, I think all the preparations for the trip wore me out," explained Nancy. "I expected to be energized by the vacation. But both yesterday and this morning as we were walking on deck, I started to feel nauseous and had trouble breathing. It scared me at first, but then it went away after I rested. Now, again, I'm having trouble walking fast."

"I don't mean to scare you, Nancy, but I think this could be serious," warned Carol. "You do?" questioned Nancy. "You look so young. Have you had these problems too?"

-Women often have symptoms of coronary heart disease or of a heart attack that are different from mens

-Her symptoms do not go away with rest

What diseases are Jim and Nancy at risk for and why?

b. What other information might be useful in assessing their health and how would it help?

Answer 1

a)Jim and Nancy are at risk of developing heart attack,because as Jim already had massive attack few years ago,still he could not control his weight and give up smoking which are risk to develop heart attack second time.
And Nancy test reports also showing elevated LDL and triglycerides .High levels of both substances are at risk of developing heart disease.

b)other information to assess their health includes,
-pain or discomfort in arms,neck,back,stomach or jaw
-cold sweat,being lightheaded
other tests which helps to assess are
-Electrocardiograph(ECG)-To assess the heart rate and rhythm.
-Cardiac enzyme tests-this test measures the level of enzyme creatinine phosphokinase (CPK) ,troponin which is released into blood stream when the heart muscle is damaged.
-Chest x-ray-it allows to check the size of your heart and its blood vessels and to look for fluid in lungs.