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Lifestyle Issues in Cardiac Health

Patient Presents

Carl Fowler, a 46-year-old man, presents to a general internist for a check-up. He had last seen a physician three years previously when he had acute bronchitis. A year ago he was told that his blood pressure was "a little high" when he donated blood. His past medical history consists of a fractured clavicle sustained when he was playing a pickup game of football at age 24. The fracture healed without complications. He had an inguinal hernia repaired at age 30. He has had no serious illnesses and has no known chronic diseases. He has no known allergies and does not take any medication on a regular basis.

Prior to seeing the internist, he fills out a history form which elicits a family history and review of systems. His father died of a heart attack at age 72. His mother is alive and well at age 76. He has a 44-year old sister who recently had a hysterectomy and has been treated several times in the past for depression. He has a 22-year old son and an 18-year old daughter who are in good health. A paternal uncle has hypertension and a maternal uncle has prostate cancer. There is no known family history of diabetes mellitus.

On review of systems, he has occasional headaches, experiences shortness of breath when he walks up stairs and gets up once a night to urinate.

Questions

1. What should the major objectives of this health maintenance visit be?
2. What conditions, risk factors and health related behaviors should be screened for during this visit?
3. What are the common causes of morbidity and mortality for 46-year-old men in the United States?