Printer-Friendly Version

Forward to a Colleague

Permission for Use

Lifestyle Issues in Cardiac Health

Followup

Discharge medications consist of metoprolol, 50 mg po BID; fluvastatin, 20 mg daily; enteric coated aspirin, 325 mg daily; nitroglycerin, 0.4 mg sublingual tablets prn chest pain. Mr. Fowler is instructed to continue his cardiac rehabilitation as an outpatient and to follow-up with his internist in a week and a cardiologist in four weeks.

He is seen by his internist a week later. He has had no chest pain or shortness of breath. He has been gradually increasing his physical activity as instructed, and has been participating in the cardiac rehabilitation program. He has not smoked cigarettes since suffering the myocardial infarction. He is cautiously optimistic that he will be able to stay away from cigarettes. He is following his low fat, low calorie, low salt diet. His children have visited him several times since the discharge and several friends and co-workers have also visited him and provided considerable support.

Mr. Fowler reports that he has been feeling very sad for several months and that the myocardial infarction has worsened his depression. He is having difficulty sleeping and has been feeling tired and irritable. The internist arranges for him to see a psychiatrist the next day and his discharge medications are continued.

On the following day, Mr. Fowler is evaluated by a psychiatrist who arranges to see him on a weekly basis for the next few weeks to manage his depression. At the time of the first visit, he is started on paroxetine, 20 mg/day.

Four weeks after the infarct, Mr. Fowler sees his internist and cardiologist. He has had no chest pain or shortness of breath. He is taking his medications as instructed. He has not smoked during the past month and is adhering to his diet. He is making good progress with the cardiac rehabilitation and feels that he is ready to return to work. He reports that his depression has substantially improved. At this time, blood pressure is 126/80 mmHg, heart rate is 70 per minute, and weight is 192 lbs. His lungs are clear, and heart sounds are normal on examination. He is cleared to return to work.

Mr. Fowler has a normal treadmill stress EKG three months after the myocardial infarction. Six months after the myocardial infarction he remains asymptomatic. His weight is 185 lbs, and his blood pressure is 126/82 mmHg. He has not smoked since the myocardial infarction. His fasting serum glucose is 100 mg/dL, his LDL-cholesterol is 105 mg/dL and his HDL-cholesterol is 36 mg/dL. At this time, his paroxetine is decreased to 10 mg a day. He is continued on metoprolol, aspirin, and fluvastatin.