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| From Medscape Cardiology To "Live Through a Day" With a PatientJ. Willis Hurst[Medscape Cardiology, 1999. © 1999 Medscape, Inc.]
The basic purpose of the heart, arteries, and veins is often forgotten or ignored. The major purpose of the heart is to pump blood. The major purpose of the arteries is to guide the blood to the cells of the body. The major purpose of the veins is to receive blood from the cells and guide it back to the heart. It is through this process that substances, some good and some bad, are delivered to the organs of the body and that other substances, some good and some bad, are removed from the organs of the body. The normal heart can pump a sufficient amount of blood to perfuse the organs of the body during a wide range of physical activity. It fails to do so when the pumping action is diminished or when an artery is occluded. During exercise the blood flow to the active skeletal muscle and cardiac muscle increases, whereas the blood flow to inactive muscle decreases. The heart accomplishes this feat mainly by increasing the rate at which it contracts and relaxes and, to some degree, by increasing its force of contraction, along with selective arteriolar dilatation and constriction. The preceding comments are the preamble to the following scenario. At times, physicians may ask a patient, "Do you become short of breath with effort?" or "Do you have chest pain due to effort?" The patient may answer "No." Such a response may be truthful, but misleading, because some patients do very little physical work. Such patients may walk slowly, climb no inclines, and sit most of the day. New insight can be gained if the physician "lives through a day" with the patient. The physician should ask the patient to relate everything he or she does, beginning with when the patient wakes up and ending with when the patient goes to bed at night. The physician must be able to visualize every move, including shaving, bathing, toweling, walking up an incline, climbing stairs, eating, talking, etc. Patients are smart. For example, a patient with stable angina pectoris or mitral stenosis may walk more slowly and avoid symptoms. "Living through a day" with the patient allows the physician to judge if the patient does little to challenge the heart and circulation or is able to participate, without symptoms, in reasonable physical activity.
The details obtained by "living through a day with a
patient" may reveal information about the activity of the patient that is
not apparent by the casual questioning.
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