1. Nutrition and Diet Therapy Case Study

2. Kadimis a 29 year old African American stock exchange manager for a large corporation. He has been feeling tightening in his chest for 3 days and now has shortness of breath and pain radiating down his left arm. Kadim thinks he is having heart attack. He was taken to the emergency and is admitted in the cardiac intensive care unit. He is placed on a cardiac monitor and is given nasal oxygen. The admitting nurse finds out that there is a history of heart attacks in young males in Kadim’s family.

3. His blood pressure is 210/110. His blood work shows cholesterol of 320, elevated triglycerides, and markedly elevated LDL. As his team of physicians and nurses get Kadim stabilized, the dietician places him on a low-cholesterol, low-fat, and low-sodium diet. The doctor suggests that Kadim participate in a candidate for heart attack but decides to play the odds, hoping they would be in his favor. After all, he did eat well and exercised regularly before he started with his firm.

4. Assessment ASSESSMENT Assessment

6. Now has shortness of breath

7. Pain radiating down his left arm

8. Kadim thinks he is having heart attack

10. His blood work shows cholesterol of 320

11. Elevated triglycerides

13. Hypertension increases the risk of coronary heart disease in several ways. First, it increases the workload of the heart, increasing oxygen demand and coronary blood flow. The increased workload also causes hypertrophy of the ventricles. Over time this can contribute to heart failure. Secondly, hypertension causes endothelial damage to the blood vessels, which stimulates the development of atherosclerosis.

15. Pain radiating down his left arm and tightening of chest are signs of myocardial infraction

19. Lowers cholesterol

20. Lowers triglycerides

21. Lowers LDL

23. 8. What dietary issues does Kadim need to learn to comply with his new diet? Low fat diet and low-cholesterol diet is prescribed for patients with cardiovascular disorders such as atherosclerosis and congestive heart failure. Since Kadim manifested signs and symptoms of developing cardiovascular disorder. A diet low in saturated fat and cholesterol can help lower blood cholesterol levels and help prevent cardiovascular diseases. A diet high in saturated fat causes cholesterol to build up in your arteries (blood vessels). Cholesterol is a soft, waxy substance that can cause

25. Prevention of heart attack We call it “HEARTBEAT”, acronym for habit, exercise, animal fats, rest, temperance, behaviour, environment, additives, and trust in God. Here they are: Habitually have a regular BP (blood pressure), ECG, and cholesterol checkup. This should be done especially if you’re male and not younger than 40, or if you’re female who is in your post menopausal age and with a positive family history of heart disease. Exercise helps lower blood pressure and cholesterol, and helps improve the circulatory process by increasing the capacity of the heart to pump blood, thus making the individual less susceptible to heart attack. Get a regular 45-minute exercise at least three to four times a week. Brisk waliking is a good form of exercise.

26. Animal products, which contain high levels of cholesterol and higher levels of saturated fats, should be eliminated from your diet. Decreasing cholesterol content of the diet will help prevent blood vessel damage. Try a vegetarian diet. Rest is very essential to the body especially to the heart which works 24 hours a day, seven days a week. Physical rest prevents your heart from getting overloaded. You need 7-8 hours of sleep during the night. Temperance should be practiced. Avoid drinks which contain alcohol or caffeine. Beer, wine, coffee, tea, and cola drinks, among other alcoholic or caffeinated drinks, unduly stimulate the sympathetic nervous system and this can cause hypertension. Avoid cigarette smoking. Reports say that the risk of a smoker’s first myocardial infarction is 2.5 times higher than that of a non-smoker. Besides nicotine, cigarette smoke contains poisons which cause heart disease and strokes.

27. Behaviourmust be in conformity to a lifestyle of healthful living. Make it your commitment. Environment is important as well. Don’t get into a stressful situation at home, unhealthy relationship with spouse and problems at work. Have a positive outlook in life. A merry heart does well like a medicine (Proverbs 17:22). Additives, too much of them, need to be avoided. Use salt and sugar sparingly. Too much salt accumulates water in the heart, thus causing increased blood pressure which will eventually lead to heart problem. Not more than one teaspoon of salt a day is recommended, with no added salt in the diet. Sugar clogs, the system and so only one tablespoon is recommended daily. Trust in God. Our world is full of insecurity, stress and uncertainty. The only assurance is to trust in God’s divine power after obeying His will. “I can do all things through Christ which strengthened me” (Philippians 4:13). How marvelous to know that with God’s new kingdom, there will be no sorrows, sickness, or death. Stop worrying. Cast all your cares upon Jesus. He is the greatest Physician, the greatest Cardiologist who can heal and restore the impaired function of the most damaged heart. (Health & Home 1999, p. 16-17)

29. Cirrhosis – Avoid medications that are harmful to liver, cut down salt, eat adequate calories and proteins, take daily multivitamin, and stop drinking alcohol

30. Renal failure – incase of recovery function is incomplete, artificial kidney can be used or dialysis, avoid self medication and cut down salts.

31. Steatorrhea and Pancreatitis – Stop alcohol consumption. Adopt a liquid diet consisting of foods such as broth, gelatin, and soups. These simple foods may allow the inflammation process to get better. Over-the-counter pain medications may also help. Avoid pain medications that can affect the liver. Lower cholesterols and fats.

32. Fat malabsorption – lower cholesterols and fats.

35. Blood pressure of 120/90

36. Lowers cholesterol

37. Lowers triglycerides

38. Lowers LDL

40. Prescribe ezetimibe with simvastatin (Vytorin) to Lower how much cholesterol your body makes and the amount of cholesterol your body absorbs

41. Prescribe atorvastatin with amlodipine (Caduet) Lower how much cholesterol your body makes and lower blood pressure

42. Prescribe niacin with lovastatin (Advicor) Raise good (HDL) cholesterol and lower bad (LDL) cholesterol

43. Worst case scenario a coronary angioplasty or heart bypass will be done to remove the cholesterol or clot on the narrow arteries and thus to make the blood flow freely.

46. Cholesterol can build up in the walls of your arteries. This buildup of cholesterol is called plaque. Over time, plaque can cause narrowing of the arteries. This is called atherosclerosis, or hardening of the arteries.

47. Special arteries, called coronary arteries, bring blood to the heart. Narrowing of your coronary arteries due to plaque can stop or slow down the flow of blood to your heart. When the arteries narrow, the amount of oxygen-rich blood is decreased. This is called coronary heart disease. Large plaque areas can lead to chest pain called angina. Angina happens when the heart does not receive enough oxygen-rich blood. Angina is a common symptom of CHD.

48. Some plaques have a thin covering and can burst, releasing cholesterol and fat into the bloodstream. The release of cholesterol and fat may cause your blood to clot. A clot can block the flow of blood. This blockage can cause angina or a heart attack.

49. Plaque and resulting health problems can also occur in arteries elsewhere in the body.

50. Stroke.