Heart Disease

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.

Since Jim is overweight, he should have a blood test done to determine if he has diabetes. One option is having a fasting plasma glucose test (FPG) performed. This would measure the glucose levels in his blood for at least 8 hours without eating anything. This test would indicate his fasting glucose level in milligrams per deciliter (mg/dL). If the results were 99 mg/dL or lower, he would be within the normal range. If it came back 100 to 125 mg/dL, this would indicate that he has pre-diabetes called impaired fasting glucose (IFG) (National Diabetes Information Clearinghouse). If it came back 126 mg/dL or higher, confirmed by repeating the test on another day, means he would have diabetes.

The other blood test Jim could have is oral glucose tolerance test (OGTT). This blood test is more sensitive compared to the FPG test. Jim would have to fast for eight hours before the test, and drink a liquid containing 75 grams of glucose dissolved in water. Two hours after he drank the glucose water, blood would be drawn. If Jim had a two-hour glucose level of 139 mg/dL or lower, he would be within the normal limits. If the results where 140 to 199 mg/dL he would have pre-diabetes, results 200mg/dL or higher would indicate the he would have diabetes (National Diabetes Information Clearinghouse).

Other information pertaining to his diet would be helpful. By knowing this information, it would show his eating patterns and what foods he favored. The types of foods that he eats could be used as an indicator to determine if he is at risk of diabetes and/or atherosclerosis.

For Nancy, it would be helpful to have the result of a second blood test, preferable the OGTT test. Since her first test indicated that, her glucose was 128 mg/dL with fasting and her triglyceride count is 220 mg/dL. This would help to determine if she is at risk for or has diabetes.

Knowing her diet is essential. If she has a diet high in saturated, (beef, pork, poultry, butter, milk, cream, etc. (American Heart Association)), and trans fats (vegetable shortenings, some margarines, crackers, cookies, snack foods, etc (US Food And Drug Administration)), she has an increased risk for atherosclerosis or a stroke (Harvard School of Public Health).

With her fear of getting osteoporosis, Nancy should have or schedule a bone density test. If she has had a bone density test, the results would indicate if she is at risk or has osteoporosis. If her T-score was above -1, her bone density is considered normal. If the result was between -1 and -2.5, her bone density is below normal and may lead to osteoporosis, If the test came back below -2.5, this would indicate that Nancy does have osteoporosis (Mayo Clinic).

With Nancy’s age, hormone therapy, and the second-hand smoke from Jim, she is at severe risk of breast cancer; the test results of a mammogram would be extremely helpful (Mayo Clinic). This information would help determine if she has breast cancer, and if so, having a core needle biopsy preformed to see what might be the cause of the cancer. If Nancy has not had a mammogram recently, or at all, she should schedule one immediately.

However, the most important information that would be helpful is a complete medical history. Not only for Jim and Nancy, but also for a complete family history. With that information, patterns of diseases can be found and it gives some information on what diseases or illnesses Jim and Nancy have a genetic predisposition for.

Part 2

Classic angina is triggered by physical exertion or by mental or emotional stress. These factors put stress on the heart and make it pump harder. Since the heart is pumping harder, it is demanding more blood; however, it is harder for the heart to receive enough blood, because the arteries have narrowed (Mayo Clinic). When an angina episode happens with classic symptoms, it usually last a short time, around five minutes. A person could feel pain similar to indigestion; however, the pain could spread to the arms and back (Mayo Clinic). These symptoms dissipate at rest or use of an angina medication.

Atypical angina symptoms occur during stressful times; however, they can also occur during rest. This is caused if plague deposits within a blood vessel and bursts or a clot is formed. This can rapidly block or further decrease flow through the already narrowed artery, swiftly and severely decreasing blood flow to the heart muscle (Mayo Clinic). This unexpected attack can last as long as thirty minutes; however, if the blood flow does not improve, the heart muscle starts to get deprived of oxygen and dies (myocardial infarction), that is if it last longer than thirty minutes (Mayo Clinic).

The risk factors for angina are smoking, high blood cholesterol or triglyceride levels, diabetes, and alcohol (Mayo Clinic).  

With smoking, damage is done to the interior walls of the arteries. This damage permits accumulation of cholesterol to gather and hinder blood flow (Mayo Clinic). Nancy presents with this risk factor even though she is not a smoker, but Jim’s secondhand smoke will cause the same amount of damage.

High blood cholesterol and/or triglyceride levels are a major cause for angina. With a high low-density lipoprotein (LDL) cholesterol level and triglyceride level, can produce deposits of plaque within the bodies’ arteries (Mayo Clinic). Nancy’s LDL and triglyceride counts are well outside the normal range (LDL – 161 mg/dL and triglyceride – 220 mg/dL).

It is not stated if Nancy has diabetes; however, with a glucose count of 128 mg/dL (outside of the normal range) she could have diabetes. With this high glucose count, her body is not using insulin properly; this misuse can lead to diabetes. Diabetes can accelerate the plaque buildup within the arteries and negatively affect blood cholesterol levels (Mayo Clinic).

Consumed in moderation, alcohol could aid in raising high-density lipoproteins (HDL) and can have a protective effect against a heart attack. However, excessive drinking can damage the heart muscle, raise blood pressure, and increase triglyceride levels (Mayo Clinic). Nancy could be drinking heavily while on the cruise.

When Jim and Nancy where walking around the deck of the boat, her body started to feel the stress within her arteries due to plaque buildup. Nancy’s symptoms lessen at rest, because she is starting to calm her body down.

When Nancy was sitting on the deck of the boat, her body was relieved from the stress of walking. Her heart started to slow down and slowly started to pump more deoxygenated blood into the lungs so that it could be re-oxygenated. This helps her lungs to “open up” and take in more oxygen. This increases her O₂ saturation, which brings vital oxygen to the heart. At rest, Nancy’s arteries are under less pressure. This less pressure helps her heart properly refill with deoxygenated blood, so that the process can start over again. This will slowly bring her body back to homeostasis.  

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