Answer Guide for Medical Nutrition Therapy: A Case Study ...



Case Questions for Medical Nutrition Therapy: A Case Study Approach 4th ed.

Title: Case 5 – Myocardial Infarction

Instructions: Answer the questions below. Please print the questions out with your answers and bring to class on the due date.

Questions:

1. Mr. Klosterman had a myocardial infarction. Explain what happened to his heart.

When someone has an MI or heart attack, it is because the heart muscle is not getting enough oxygen. The cells surrounding the heart start to die, which leads to a heart attack. Often times this is caused by a blockage of plaque, which causes a roadblock to the heart and oxygen can not reach it, eventually leading to a heart attack.

2. Mr. Klosterman’s chest pain resolved after two sublingual NTG at 3-minute intervals and 2 mgm of IV morphine. In the cath lab he was found to have a totally occluded distal right coronary artery and a 70% occlusion in the left circumflex coronary artery. The left anterior descending was patent. Angioplasty of the distal right coronary artery resulted in a patent infarct-related artery with near-normal flow. A stent was left in place to stabilize the patient and limit infarct size. Left ventricular ejection fraction was normal at 42%, and a posterobasilar scar was present with hypokinesis. Explain angioplasty and stent placement. What is the purpose of this medical procedure?

Angioplasty is used when someone has a blockage in their arteries. This is what starts as coronary heart disease and leads to a heart attack if nothing is done. Angioplasty is done by inserting a catheter through the arm or thigh. The tip of the catheter has a balloon like object on it, and when it is by the clotted artery, it inflates and pushes the plaque aside to help open the artery back up.

When a stent is used, it is usually used after the angioplasty is performed, and it is placed in the artery to help ensure that the artery stays open.

3. Mr. Klosterman and his wife are concerned about the future of his heart health. What role does cardiac rehabilitation play in his return to normal activities and in determining his future heart health?

Cardiac rehab is a supervised program for people who are recovering from a heart attack or other heart complications. By going to rehab, Mr. Klosterman and his wife will learn helpful education on how to deal with the aftermaths of an MI. In rehab, more patients learn how to safely increase their exercise levels, improve their health, and lower their risk of future heart problems.

4. What risk factors indicated in his medical record can be addressed through nutrition therapy?

Looking at his records, he has a history of smoking, a poor diet with a high intake of fat, as well as low physical activity all of which puts a person at high risk of having an MI.

5. What are the current recommendations for nutritional intake during a hospitalization following a myocardial infarction?

Mr. Klosterman was ordered NPO until procedure is completed and then clear liquids- no caffeine.

6. What is the healthy weight range for an individual of Mr. Klosterman’s height?

106 + 6 lbs for every inch over 5 ft.

106 + (6 x 10) = 166 lbs

Range between 131-174 for a healthy BMI

7. This patient is a Lutheran minister. He does get some exercise daily. He walks his dog outside for about 15 minutes at a leisurely pace. Calculate his energy and protein requirements.

5 + 10 (84) + 6.25 (178) – 5 (61)= 845+ 1112.5-305 = 1652 kcal

1652 (1.3)= 2148 kcal

67 g/d- protein

8. Using Mr. Klosterman’s 24-hour recall, calculate the total number of calories he consumed as well as the energy distribution of calories for protein, carbohydrate, and fat using the exchange system.

Using his calorie intake was 2405 kcal

149 g for protein (25%)

305 g for carbs. (51%)

71 g for fat (27%)

9. Examine the chemistry results for Mr. Klosterman. Which labs are consistent with the MI diagnosis? Explain. Why were the levels higher on day 2?

CPK and CPK-MB is elevated day 2 and 3 indicating damage to cardiac muscle (clot was broken and that decreased levels some on day 3);

Trop I and T are increased day 1 and 2 indicating a MI had occurred;

LDH is elevated day 2; it is used to help diagnose and monitor a heart attack;

AST is elevated day 2 and 3; it increases after a heart attack;

High cholesterol, high LDL, and low HDL increase risks for cardiovascular disease.

10. What is abnormal about his lipid profile? Indicate the abnormal values.

Cholesterol (mg/dL)- Mr. Klostermans: 235-214 normal: 120-199

HDL (mg/dL)- Mr. Klostermans: 30-33 normal: >55 (low)

LDL (mg/dL) Mr. Klostermans: 160-141 normal: ................
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