Tim goes to his family physician complaining of worsening angina, shortness of breath, and extreme fatigue. Tim is 5’11”, 240 lbs, and 68 years old. He has a history of smoking (one pack a day for 40 years), and is on the verge of Type II diabetes. Tim has been previously diagnosed with atherosclerosis, and has had bypass surgery to correct 2 blocked coronary arteries. A year ago, Tim had a heart attack and spent a couple of months in the hospital, during which he quit smoking.
Tim is retired, and leads a virtually sedentary lifestyle. He goes for a walk with his wife one or two times a week when she drags him out, but lately he’s been too tired even to do that. He tries to watch what he eats – he avoids sweets most of the time, but still consumes a relatively high fat diet and has at least one beer every evening. He’s a bit concerned about his condition, but apart from the occasional chest pain and fatigue, claims that he feels “just fine”.
Tim’s vitals at the doctor’s office are as follows:
HR 90 bpm; slightly irregular
Respirations – slight tachypnea, shallow
His last bloodwork revealed the following:
Total cholesterol – 240 mg/dL
HDL – 31 mg/dL
LDL – 140 mg/dL
Fasting glucose – 100 mg/dL
Slightly elevated CRP
Further imaging has shown blockage in a new coronary vessel, and Tim wants to have another bypass surgery (this would mean he would have 3 total coronary arteries bypassed).
- Is Tim a good candidate for bypass surgery? Why or why not? Give 3 reasons to support your answer. (4 pts)
- Tim could also make lifestyle modifications – but he has not yet committed to making any major changes. Describe how you could convince him to make those necessary changes to his lifestyle. (3 pts)
- Do you think Tim’s health insurance should pay for this bypass surgery? Why or why not? (3 pts)