MEDIUM RISK CARDIAC PATIENT

1. MEDIUM RISK CARDIAC PATIENT

2. Meet Mrs.EJ 68 year old female Homemaker, enjoys gardening Weight 59 kg, height 157 cm Supportive family

3. History of Mrs. EJ Left Carotid Endarectomy Aug. 5, 1999 CABG x 3 August 30, 1999 Peripheral Vascular Disease Hiatus hernia Arthritis

4. Risk Factors of Mrs. EJ Hypertension Dyslipidemia Family History Stress

5. Medications of Mrs. EJ Ticlid 250 mg BID Atenolol 50 mg OD Norvasc 15 mg OD Furosemide 40 mg OD Slow K OD Lipitor 20 mg OD Arthrotec 50 mg TID Paxil 20 mg OD Coumadin 5-7.5 mg on alternate days Oxazepam 15 mg prn

6. Mrs. EJ’s Test Results Stress test on treadmill on October 29, 2002 - she exercised for 4:38 and her ECG was equivocal due to 0.5 mm horizontal ST segment depression Lipid profile in September 2002 Cholesterol 5.64 HDL 1.78 LDL 3.24 Trig. 1.36 BMI is 24, W:H is .80

7. Mrs. EJ’s Exercise Recovery Program - exercise up to 15 minutes on bike and treadmill attaining heart rates of 79-86 bpm. Maintenance Program - start on bike and arm erg for 5 minutes each due to inactivity and problems with PVD - increased slowly to 15 minutes on bike and 15 minutes between arm erg and track as PVD improved

8. Mrs. EJ’s Risk Stratification Risk of Disease Progression 5.6 Risk of Acute Event 16.0 Total 21.6

9. Mrs. EJ’s Risk Factor Modification Hypertension -medication -maintain weight -maintain exercise -low salt diet

10. Mrs. EJ’s Risk Factor Modification Dyslipidemia -medication -exercise to increase HDL -decrease total fat in diet

11. Mrs. EJ’s Risk Factor Modification Stress -exercise -rest -assess psychological well being -assess family and social support -medication

12. Mrs. EJ’s Risk Factor Modification Exercise F - 5 days per week I - THR of 89 - 102 bpm or RPE 11-13 T - consider PVD- walking ,biking T - maintain 30 minutes and increase to 40-60 minutes if tolerated

13. The Plan for Mrs. EJ Continue exercise Low fat/salt diet Follow up Call if have problems or concerns