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Points for Reflection

1. If you were approached by a patient with a health history similar to that of Grahamís, what would you say?

2. How would you explain the importance of a healthy lifestyle, without unduly worrying him and his family?

Activities

1. Would you suggest a referral to a colleague and to whom?

2. Would you be able to direct him to helpful information resources as Graham had from the British Heart Foundation?

3. How would you direct any of this information to other family members?

Quotes

"After having taken my health for granted until then, I thought I had better find out a bit more about my family and heart problems."

"For me, life goes on as before. For my family, the healthier lifestyle will prolong their lives."

"I have two sons and eight grandchildren. What do I do, I canít change their genetics?"

"It seems to me that people find out about genetic problems when it is too late to take any meaningful action."

Further information

The British Heart Foundation (BHF) http://www.bhf.org.uk/ plays a leading role in the fight against disease of the heart and circulation so that it is no longer a major cause of disability and premature death. It produces information and literature to help people help themselves and improve their health.

Heart UK http://www.heartuk.org.uk/ supports all those at risk of high cholesterol and cardiovascular disease.


Location: The Stories
Transcript

You can download the full transcript here

Grahamís story: Like father, like son?
Hypercholesterolaemia and a family history of heart disease

It all started about 6pm on the 7th June 2002. There I was with my family and friends when I felt tired and unwell and went upstairs to bed. My wife was about to call the doctor when I said to her ďCall an ambulanceĒ and immediately afterwards, I had the most terrible pain across my chest and I could not breathe. I had a heart attack. Looking back, there were some signs of shortage of breath several weeks before which I had ignored.

The paramedics arrived shortly afterwards, gave me oxygen and I was off to hospital for six days. There I was given a range of tests but I did not see a consultant cardiologist. Twice, I complained about discomfort in my chest in hospital but this was attributed to indigestion. When in hospital, a conversation with two other heart attack patients really made me think. Our fathers all had heart attacks and guess what? At exactly the same age that each of us had heart attacks. In my case I was 67 years old at the time and my father died when he was 67. I will never forget that conversation! Next day, I was discharged from hospital with an appointment to see a cardiologist in six weeks time.

Next day at home, I had chest pains when inactive and I was sure I had unstable angina. My excellent GP referred me to a cardiologist. I had an angiogram and two days later, a heart bypass.

After having taken my health for granted until then, I thought I had better find out a bit more about my family and heart problems, especially in view of the conversation in hospital. In general, I found out that females lived about 20 years longer than the males in my family. My mother died at 89 and her sisters mainly in their eighties and nineties. Uncles died in their fifties and sixties mainly from heart problems. Some of the surviving females suffered from stable angina, uncles died from heart attacks.

I have two sons and eight grandchildren. What do I do, I canít change their genetics? Fortunately, I attended a NHS cardiac rehabilitation course at the time and learned a bit about lifestyles. I realised that cardiac risk factors were worth studying. I also studied British Heart Foundation booklets which contain some excellent information and I strongly recommend them.

My father smoked, had an unhealthy diet, exercised a reasonable amount. He was a relaxed character and did not take alcohol. I do not smoke, had a reasonable diet and exercise a lot. I have my motherís temperament of wanting to get things done and I drink moderately, about 10 units per week. After studying risk factors, I decided to change my diet by reducing salt intake and levels of saturated fats.

I take 75 milligrams of aspirin and one beta blocker each morning and a simvastatin in the evening to lower my cholesterol level. I still exercise a lot.

I talked to my sons about genetics and their lifestyle risk factors and those of their children. As a result, one of my sons has given up smoking and the other one has improved his diet dramatically. They both exercise a lot, have very good diets, low in salt and saturated fats with lots of fruit and vegetables. They are both high achievers and ambitious and as a result are subjected to stress in their jobs! They are well aware of the need to keep cholesterol levels monitored and under control. Their children are given healthy diets.

For me, life goes on as before. For my family, the healthier lifestyle will prolong their lives.

I have mentioned the genetic risk of family heart problems to doctors in response to questioning or during a conversation. The information was only used as part of my diagnosis and was not followed up with any of my family. I have not had any discussions with nurses on the subject. It seems to me that people find out about genetic problems when it is too late to take any meaningful action. For example, why does the medical profession not have a more detailed discussion on genetics with parents when a baby is born or even earlier?

Collecting family histories is one useful way of determining possible genetic issues. I have found that my family members are very willing to talk about health issues in a constructive way. Recurring medical issues can be identified; both genetic and environmental factors may be considered.

From other activities that I now do, I am aware of two issues affecting cardiac rehabilitation and lifestyle. One is to get patients to start cardiac rehabilitation and then to get them to continue with it. The other is persuading patients to continue to exercise and to follow a sensible diet after cardiac rehabilitation has "finished".

Healthcare professionals have a role to play in encouraging patients in these areas.