Download Case Study Heart Disease

Running head: CARDIOVASULAR DISEASE
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Case Study - Cardiovascular Disease
By June Saxton
9/10/2013
The patient evaluated for this case study is a corporate lawyer age 55. When he
was seen a year ago, he was 15 lbs. overweight, his blood pressure was 140/85 and his
cholesterol was 225 mg/dl. He works long, hard days and does not get much exercise except
occasional golfing. Three month after his physical he collapsed after a sudden onset of chest
pain. He was brought to the ER where he presented pale, short of breath, cold, sweaty and
vomited. His blood pressure was down to 100/70. He was placed on bed rest for the first three
days in the hospital and prescribed a liquid diet. His diet progressed to a 1000 calorie soft diet
on the fourth day. By the end of the week, he was able to eat a regular 1200 calorie low-saturated
fat, low cholesterol diet.
Myocardial infarction
A Myocardial infarction is the proper medical term for a heart attack. In Myocardial
infarction some of the muscle cells die from lack of air and other nutrients. This causes the
coronary artery to close and cutting off the hearts supply of blood. Most of the time this is caused
by hardening of the arteries. The cholesterol blockage in the artery can rupture and block the
flow of blood (Kulick, 2013).
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High Risk Lifestyle Factors
The predisposing lifestyle factors that put the patient in the high risk category were:
1. Being overweight – According to the CDC the normal weight range for his height is
129 – 174 pounds. I am assuming that he is at the high end of the range because his
doctor is telling him to lose 20 pounds. If he was 189, his BMI would be 27.1 which
puts him in the overweight category according to the CDC BMI calculator (CDC,
2011). As BMI goes up, the risk of CHD increases (Mahan, Escott-Stump &
Raymond, 2012).
2. His blood pressure is high a 140/85. This level of blood pressure is associated with
increased risk of CVD (Mahan, Escott-Stump & Raymond, 2012).
3. His total cholesterol is in the borderline high range according the American Heart
Association (2013).
4. He does not participate in a regular exercise program. This is one of the top risk
factors for heart disease (WebMD, 2013). The fact that he is working long hectic days
does not give him much time to exercise.
Reasons for Diet Modifications
When the patient first came into the hospital he was put on a clear liquid diet because he
was vomiting shortly after he arrived in the emergency room. This diet reduces the risk of further
vomiting and to empty the stomach in case other cardiac procedures were necessary (Remedy
Health Media, LLC, 2013). He was then placed on a 1000 calorie soft diet. It is important to use
a progressive approach to transition the patient from a liquid diet to make sure the more solid
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food will be tolerated without causing gastric distress (Mahan, Escott-Stump & Raymond, 2012).
After his appetite improved and the soft diet was well-tolerated he was progressed to a 1200
calorie, low-saturated fat, low cholesterol diet. This diet is in line with the recommendations for
a heart healthy diet (American Heart Association, 2013). The reason was the 1200 calorie limit is
to help him lose the 20 pounds that the doctor recommends to get his BMI within the normal
range.
Final Diet Order
The patients final diet order of no more than 300 mg of cholesterol, total fat limited to
20% of total calories and not more than 7% saturated fat is appropriate for his lipid disorder
because it will decrease his blood cholesterol level which will help to prevent another heart
attack (National Heart Lung and Blood Institute, n.d.). Dietary lipids strongly affect CVD risk
(Mahan, Escott-Stump & Raymond, 2012).
Advice for patient’s wife on shopping for and preparing prescribed diet
Some advice I would give to the patient’s wife with regard to shopping and preparing for
the foods recommended on the diet are:
1. Read food labels and pay special attention to amount of total fat, saturated fat and
cholesterol.
2. Choose non-fat, reduced-fat or low-fat milk and cheeses.
3. Buy fresh fruits and vegetables, whole grains and lean meats and basing meals on
them make the job of reducing fat and cholesterol easier.
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4. Use limited amounts of fats and oils in baking and cooking and choose the ones
lowest in saturated fat, trans fat and cholesterol or use a non-stick pan or vegetable oil
spray.
5. Look for the “Heart Check Mark” on foods and meals because this mark helps
identify foods that meet the American Heart Association’s guidelines for heart
healthy foods (American Heart Association, 2013).
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References
American Heart Association (2013). Heart-smart shopping. Retrieved from
http://www.heart.org/HEARTORG/GettingHealthy/NutritionCenter/HeartSmartShopping
/Heart-Smart-Shopping_UCM_001179_SubHomePage.jsp
American Heart Association. (2013). Diet and lifestyle recommendations. Retrieved from
http://www.heart.org/HEARTORG/GettingHealthy/Diet-and-LifestyleRecommendations_UCM_305855_Article.jsp
American Heart Association. (2013). What your cholesterol levels mean. Retrieved from
http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/WhatYour-Cholesterol-Levels-Mean_UCM_305562_Article.jsp
CDC. (2011, May 4). Healthy weight - it's not a diet, it's a lifestyle!. Retrieved from
http://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator
Kulick, D. L., M.D. (2013, April 4). Heart attack (myocardial infarction). Retrieved from
http://www.medicinenet.com/heart_attack/article.htm
Mahan, L., Escott-Stump, S. & Raymond, J. (2012). Krause’s Food & Nutrition Care
Process. 13th edition. St. Luis, Mo. Elseveir Inc.
National Heart Lung and Blood Institute. (n.d.). Therapeutic lifestyle changes diet. Retrieved
from http://www.nhlbi.nih.gov/cgi-bin/chd/step2intro.cgi
Remedy Health Media, LLC. (2013). Heart attack patient guide. Retrieved from
http://www.healthcentral.com/heart-disease/patient-guide-44609-6.ht
WebM.D. (2013). Heart disease: Exercise for a healthy heart. Retrieved from
http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/WhatYour-Cholesterol-Levels-Mean_UCM_305562_Article.jsp
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Appendix
This is based on the 1200 calorie, low-saturated fat, low-cholesterol diet that the patient
was eating at discharge. Personally, I feel that this is way too low for a man of his height and
weight even as a weight-loss plan. I think that it is possible to get him down to a healthy weight
and BMI on an 1800 calorie a day diet.
Food
Serving Calories Cholesterol Total
Saturated
Size
Fat
Fat
1% milk
8 oz.
86
5 mg
0
0
orange
medium
62
0
0
0
spoon sized shredded wheat
½ cup
85
0
0
0
pot roast
2 oz.
133
56 mg
6g
2g
whole wheat sub roll
1 small
262
0
4g
1g
romaine lettuce
1 leaf
2
0
0
0
tomato
3 slices
11
0
0
0
cucumber
3 slices
3
0
0
0
mayonnaise
1 tbsp.
36
4 mg
3g
1g
fresh green beans
½ cup
44
0
0
0
salmon
4 oz.
166
74 mg
5g
1g
mashed sweet potato with salt and
¾ cup
161
2 mg
5g
1g
1
72
0
0
0
98
5 mg
0
0
1221
146
23
6
margarine
apple
medium
vanilla yogurt
Totals
8 oz.
Nutrition Information from: http://www.supertracker.usda.gov/