HEART PATIENT

INTRODUCTION
Each player takes the role of a Heart patient.

OBJECT
Be the patient to live the longest.

THE DECK
Players share a common deck.
The deck contains 6 types of cards:
1. Medical Interventions
2. Lifestyle Modifications
3. Surgery
4. Pathological Events
5. Drug Therapies
6. Heart Attack Cards
All the types of cards are shuffled together into a single deck.

SETUP
Each player rolls up a character or patient.
For each patient roll for the 17 Risk Factors.
Shuffle the deck.

TURN SEQUENCE
Players take turns.
The player with the most real life risk factors goes first.
On your turn draw one card from the deck.
If the deck runs out shuffle the discard and draw from it.
If the draw is a Medical Interventions or Surgery card, put it into your hand
to be used later.
If the draw is a Lifestyles Modifications card play it immediately
(face down to the table in front of you).
The effects of a Lifestyles Modification card lasts for the rest of the game.
If the draw is a Pathological Events card play it immediately
(face down to the table in front of you).
The effects of a Pathological Events card lasts for the rest of the game.
If the draw is a Drug Therapy card put it in your hand or play it immediately
(face down to the table in front of you).
The effects of a played Drug Therapy card lasts for the rest of the game.
If the draw is a Heart Attack Card see the Heart Attack Rolls Section.

HEART ATTACK ROLLS SECTION
Heart attack cards indicate conditions that may precipitate a Heart Attack or MI (Myocardial Infarction)
When a player draws a Heart Attack card he must make a Heart Attack Roll:
Roll the ten sided die once (1D10).
Add all modifiers. Some are positive (Bad), some are negative (Good).
Modifiers come from:
The patients original Risk Factors.
Drug Therapy, Pathological Events, and Lifestyle Modifications in play.
Drug Therapy, Medical Interventions, and Surgery cards played from the players hand.
Every Bad Risk factor adds +1 to your heart attack roll.
Every Very Bad Risk factor adds +2 to your heart attack roll.
Every Very Very Bad Risk factor adds +3 to your heart attack roll.
If your modified Heart Attack Roll is 10 or greater, then you die.
A player may discard drug therapy cards, and intervention cards to further
modify the roll.
A player may discard a Heart Attack card before the roll is made by
discarding a Monitoring card.
As soon as a player survives his first Heart Attack roll he is considered
to have Coronary Heart Disease (CHD)
The terms Coronary Heart Disease (CHD) and Ischemic Heart Disease (IHD) are synonymous.
If you survive you also gain the trait s/p MI. (Status Post MI, meaning you’ve
had a heart attack)
Players with s/p MI (CHD) get a +1 to all future heart attack rolls.
The terms Heart Attack and Myocardial Infarction (MI) are synonymous.
DOC = Drugs of Choice. If you have a DOC for a condition get –1 to your heart attack roll.
For Heart Attacks the DOCs are Diuretics & Beta Blockers.
Medical Intervention Cards and Surgery Cards are discarded after being used.

RISK FACTORS

1. SEX
1D6 Sex
1-3 Male (Bad)
4-6 Female (OK)

2. RACE
1D6 Race
1-3 White (DOC: Beta Blockers, ACE Inhibitors)
4-6 Black (DOC: Calcium Channel Blockers, Diuretics)

3. AGE
1D6 Age
1-2 Younger
3-4 Middle age >45 Males, >55 Females (Bad)
5-6 Older >55 Males, >65 Females (Very Bad)

4. FAMILY HISTORY
1D6 Family History of Cardiovascular Disease
1-4 No Incidence (OK)
5-6 Yes (Bad)

5. SMOKING
1D6 Smoking
1-4 None (OK)
5 1 Pack per Day (Bad)
6 2 PPD (Very Bad)

6. BLOOD PRESSURE
1D10 Blood Pressure (Systolic/Diastolic)
0 <120/80 Optimal
1 <130/85 Normal
2 >130/85 High Normal
3-7 140/90+ Stage 1 Hypertension (Bad)
8-9 160/100+ Stage 2 (Very Bad)
10 180/110+ Stage 3 (Very Very Bad)

7. ALCOHOL
1D6 Alcoholism
1-5 None
6 Heavy Drinker (Bad) +1 to roll on following table

8. CLINICAL HISTORY
1D6 History of Cardiovascular Accidents/Disease
1-5 None
6 Yes. Roll on the Major Complications Table

9. MAJOR COMPLICATIONS TABLE
1D10 Complication (all are Very Bad Risk Factors)
1 Hypothroidism
2 Renal Disease
3 Liver Disease
4 Non-Insulin-Dependent Diabetes (DOC: ACE Inhibitors)
5 Pulmonary Disease
6 Familial Hypercholesterolemia
7 Gout (DC Diuretics)
8-10 Previous MI

10. LDL
1D6 Low Density Lipoproteins {Lipids}
1-3 Low (OK) Actual numbers depend on presence of CHD and number of other risk factors
4-6 High (Bad) Initiate Drug Therapy

11. HDL
1D6 High Density Lipoproteins {Lipids}
1-2 <35 (Bad) Initiate Drug Therapy
3-5 35-60 (OK)
6 <60 (Good) Negative Risk Factor (Heart Attack Roll Modifier –1)

12. TG
1D6 Triglycerides {Lipids}
1-2 Below 250
3-4 251-400 (OK)
5-6 Above 400 (Bad) Initiate Drug Therapy

13. TOTAL CHOLESTEROL
1D6 Total Cholesterol {Lipids}
1 Below 200
2-3 200-240 (OK)
4-6 Above 240 (Bad) Initiate Drug Therapy

14. DIABETES
1D6 Diabetes
1-4 No
5-6 Yes (Very Bad), DC Beta Blockers & Diuretics, DOC: ACE Inhibitors

15. PHYSICAL ACTIVITY
1D6 Physical Activity
1-5 Sedentary (Bad)
6 Active

16. WEIGHT
1D6 Weight
1-3 Normal
4-6 Overweight (Obese) Bad

17. SALT SENSITIVITY
1D6 Salt Sensitivity
1-3 Normal
4-6 Sensitive (Bad)

CARD LIST: MEDICAL INTERVENTIONS
Physical Examination Monitoring
Clinical Evaluation Monitoring
Laboratory Tests Monitoring
Patient Education Monitoring
Follow-up Visits Monitoring
ECG (Electrocardiogram) Monitoring
Exercise Tolerance Testing Monitoring (The Treadmill)
Cardiac Imaging Monitoring
Ambulatory Holter Monitor Monitoring
Stress Thallium Scan Monitoring (Invasive)
Cardiac Catheterization Monitoring (Invasive)
SL NTG Sublingual Nitroglycerin. Heart Attack Roll Modifier –2
IV NTG Intra-Venous Nitroglycerin. Heart Attack Roll Modifier –3
Oxygen Heart Attack Roll Modifier –1
IV Morphine Heart Attack Roll Modifier –1
Unfractionated Heparin Heart Attack Roll Modifier –4
Enoxaparin Heart Attack Roll Modifier –4 (Low MW Heparin)
Dalteparin Heart Attack Roll Modifier –4 (Low MW Heparin)
Glycoprotein IIb/IIIaInhibitors Heart Attack Roll Modifier –2
Streptokinase Thrombolytic. Heart Attack Roll Modifier –4
Reteplase Thrombolytic. Heart Attack Roll Modifier –5
Tenenecteplace Thrombolytic. Heart Attack Roll Modifier –5
Lidocaine Anti-arrhythmic. Heart Attack Roll Modifier –3

CARD LIST: SURGERIES
Stent Heart Attack Roll Modifier –6
Angioplasty Heart Attack Roll Modifier –5
Coronary Artery Bypass Graft Heart Attack Roll Modifier –7 (CABG)
Heart Transplant Heart Attack Roll Modifier –10 (Very Rare)
Artificial Heart Heart Attack Roll Modifier –9 (Very Rare)
Pace Maker Heart Attack Roll Modifier –8

CARD LIST: LIFESTYLE MODIFICATIONS
Smoking Cessation Program Smoking Risk Factor becomes none.
Dietary Therapy Step I Weight becomes normal
Dietary Therapy Step II Weight becomes normal
Registered Dietician Negate 1 Lipid Risk Factor or weight becomes normal
Aerobic Exercise Program Physical Activity Risk Factor becomes Active
Alcoholics Anonymous Alcohol Risk Factor becomes None.
Noncompliant Discard any one of an opponent’s Drug Therapies.
Sodium Salt Restriction Heart Attack Roll Modifier –1.
Mineral Supplements Heart Attack Roll Modifier –1. (Potassium, Ca, & Mg)

CARD LIST: PATHOLOGICAL EVENTS
Myalgia/ Arthalgia
Discontinue (DC) all Hmg CoA reductase Inhibitors.
Flushing, Itching, GI Upset
Discontinue Niacin and Niaspan.
Constipation, Bloating
Discontinue Verapamil, Gemfibrozil, Fenofibrate, and Bile Acid Resins.
Liver Function Test is High
Discontinue all lipid lowering drugs except Bile Acid Resins.
Congestive Heart Failure (CHF)
Only if patient is s/p MI. Very Bad Risk Factor. (Heart Failure)
Chronic Obstructive Pulmonary Disease(COPD)
Only if patient is s/p MI. Very Bad Risk Factor. DC Beta Blockers. (Heart Failure)
Left Ventricular Hypertrophy
Only if patient is s/p MI. Very Bad Risk Factor. (Heart Failure)
Myocardial Necrosis
Only if patient is s/p MI. Very Bad Risk Factor. (Heart Failure)
Ventricular Remodeling
Only if patient is s/p MI. Very Bad Risk Factor. (Heart Failure)
Cardiogenic Shock
Only if patient is s/p MI. Very Bad Risk Factor. (Heart Failure)
Coronary Atherosclerosis
If the patient has any bad lipid levels. Increase Blood Pressure one step.
Atherosclerotic Plaques
If the patient has any bad lipid levels. Increase Blood Pressure one step.
Homocystinemia
Bad Risk Factor
Arteriolosclerosis
Bad Risk Factor
Essential Hypertension
Increase Blood Pressure one step.
Secondary Hypertension
Increase Blood Pressure one step.
Malignant Hypertension
Increase Blood Pressure one step. (Diastolic >120)
Second Degree Heart Block
Discontinue Beta Blockers
Renal Insufficiency
Very Bad Risk Factor. DOC: ACE Inhibitors
Dry Cough
Discontinue ACE Inhibitors & Angiotensin II Receptor Blockers
Bradycardia
Discontinue Beta Blockers, CCBs
Isolated Systolic Hypertension
Increase Blood Pressure one step.
Bleeding
Discontinue Blood Thinners
Dyslipedemia
LDL levels go up one step.
Endocarditis
Bad Risk Factor
Mitrostenosis
Bad Risk Factor
For Heart Failure the Drugs of Choice (DOC) are: ACE Inhibitors & Diuretics.

CARD LIST: DRUG THERAPIES
Zocor Hmg CoA reductase Inhibitor. Negate 1 Lipid Risk Factor
Lipitor Hmg CoA reductase Inhibitor. Negate 1 Lipid Risk Factor
Baycol Hmg CoA reductase Inhibitor. Negate 1 Lipid Risk Factor
Mevacor Hmg CoA reductase Inhibitor. Negate 1 Lipid Risk Factor
Pravachol Hmg CoA reductase Inhibitor. Negate 1 Lipid Risk Factor
Lescol Hmg CoA reductase Inhibitor. Negate 1 Lipid Risk Factor
Niacin Lipid Lowering Vitamin. Negate 1 Lipid Risk Factor except LDL
Niaspan Lipid Lowering Vitamin. Negate 1 Lipid Risk Factor except LDL
Cholestyramine Bile Acid Resin. Negate 1 Lipid Risk Factor except LDL
Colestipol Bile Acid Resin. Negate 1 Lipid Risk Factor except LDL
Gemfibrozil Uptakes lipids into tissues. Negate 1 Lipid Risk Factor except LDL
Fenofibrate Uptakes lipids into tissues. Negate 1 Lipid Risk Factor except LDL
Aspirin Blood Thinner. Heart Attack Roll Modifier -1
Plavix Blood Thinner. Heart Attack Roll Modifier -1
Coumadin Blood Thinner. Heart Attack Roll Modifier -1
Warfarin Blood Thinner. Heart Attack Roll Modifier -1
Transdermal Patch NTG vasodilator. Heart Attack Roll Modifier -1
Isosorbide Dinitrate NTG vasodilator. Heart Attack Roll Modifier -1
Imdur NTG vasodilator. Heart Attack Roll Modifier -1
Atenolol Beta Blocker. Slows Heart Rate. Decrease Blood Pressure one step.
Metoprolol Beta Blocker. Slows Heart Rate. Decrease Blood Pressure one step.
Tenormin Beta Blocker. Slows Heart Rate. Decrease Blood Pressure one step.
Lopressor Beta Blocker. Slows Heart Rate. Decrease Blood Pressure one step.
Nifedipine Calcium Channel Blocker (CCB). Decrease Blood Pressure one step.
Verapamil Calcium Channel Blocker. Decrease Blood Pressure one step.
Diltiazem Calcium Channel Blocker. Decrease Blood Pressure one step.
Hydrochlorothiazide Diuretic. Decrease Blood Pressure one step.
Triamterene Potassium Sparing Diuretic. Decrease BP one step.
Maxide Combination Diuretic. Decrease BP one step.
Clonidine Patch Central Alpha Agonist. Decrease Blood Pressure one step.
Captopril ACE Inhibitor. Decrease Blood Pressure one step.
Lisinopril ACE Inhibitor. Decrease Blood Pressure one step.
Enalapril ACE Inhibitor. Decrease Blood Pressure one step.
Losartan Angiotensin II Receptor Blocker. Decrease Blood Pressure one step.
Notes: A patient can only be on one Drug of a class at a time.
For example a patient can only be on one Beta Blocker.
Treat Losartan like an ACE I.

CARD LIST: EVENTS: HEART ATTACK CARDS
Sign or Symptom of MI (Myocardial Infarction): Heart Attack Roll Modifier:
Effort Induced Angina +1
Unstable (Rest) Angina +2
Anxiety, Nausea, dizziness, SOB, dyspnea +1
Vasospastic Angina +0
Increased Myocardial Oxygen Demand +1
Silent MI +0
Exacerbating Factor: Cold +0
Exacerbating Factor: Physical Activity +0
Exacerbating Factor: Sex +0
Exacerbating Factor: Stress +0
Exacerbating Factor: Sympathomimetic Drug +1
Exacerbating Factor: Anticholinergic Drug +1
Hypertensive Urgency +3
Hypertensive Emergency +5
Stroke (Not MI) +4
Aneurysm(Not MI) +4
Cerebral Hemorrhage(Not MI) +6
Cerebrovascular Accident +5
Pulmonary Embolism (Not MI) +3
Deep Vein Thrombosis +5
Acute Coronary Syndrome +1
Ventricular Rupture & Cardiac Tamponade +8 Only if patient is s/p MI
Saddle Embolus +6
ST-Segment Elevation +4
Non-Q-Wave Infarction +5
Q-Wave Infarction +7
Coronary Artery Thrombosis +3
Plaque Rupture +2
Cardiac Arrest +3
Elevated Cardiac Enzymes +3 (CK, CK-MB, Troponin I, LDH)
Virchow’s Triad +3 (Venous Stasis, Vascular Injury, Hypercoagulability)

GAME DESIGNERS NOTES
My apologies to anyone who might be offended by the subject matter.
The goal is to be educational, not morbid.
Expect additional cards and minor rules alterations.
When I'm not writing games, I'm a second year Pharmacy Student.

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