Tim goes to his family physician complaining of worsening angina, shortness of breath, and extreme fatigue.

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”.

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Tim’s vitals at the doctor’s office are as follows:

HR 90 bpm; slightly irregular

BP 140/80

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

Slight hypernatremia

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).

What surgical treatment would you suggest for Tim at this point? Give 3 reasons for your answer. (4 pts)

Explain how would each of the following improve Tim’s cardiovascular health:

Quitting smoking (1 pt)

Eating a healthier diet and decreasing alcohol consumption (1 pt)

Exercising (1 pt)

Managing his diabetes (1 pt)

What type of heart failure (left, right, or biventricular) is Tim at risk for developing? Explain your choice. (2 pts)

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