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Running head: CARDIOVASULAR DISEASE 1 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). CARDIVASULAR DISEASE 2 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 CARDIVASULAR DISEASE 3 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. CARDIVASULAR DISEASE 4 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). CARDIVASULAR DISEASE 5 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 CARDIVASULAR DISEASE 6 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/