MNT Case Study

Myocardial Infarction
Patient M.K
Brittany Brockner

Patient Description
Demographics
-62 yr old German American Male, English speaking
- Married to S.K, a 59 yr old women
- Him and wife live in their home together. Wife does all the food
Preparation
- Fulltime Lutheran Minister
- Two children who are adults and do not live with him anymore

Patient Description
Medicine and Usage
Did not take any medicine prior to admittance
Allergic to Sulfa drugs (antibiotics)
Current hospital order is: Chewable aspirin 160mg
continues everyday, and Lopressor (beta blocker) 50 mg
twice daily

Patient Description
Histories

Emesis and nausea

Denies previous diagnosis of hypertension, diabetes or high

cholesterol

Two surgeries: Cholecystomy 10 years ago & Appendectomy

30 years ago

Father experience MI at age 59

Patient smokes 1 pack of cigarettes per day for the past 40

years (risk factor!)

No food allergies and supplements

Disease Etiology
Myocardial infarction

Typically caused from a build up of atherosclerotic plaque

A blocked coronary artery interferes with blood flow & its

ability to pump blood

Coronary Angioplasty

Angioplasty of the infarct related artery

Surgically unblocks the blocked blood vessel

Blood thinner- IV heparin 5,000 units followed by

1000unit/hr

Hospital diet order- Clear liquids with no caffeine until

surgery is completed

Admitting Signs/Symptoms
Unstable angina

On his way home from work

Related to blocked coronary artery

Nausea & Vomiting

American Journal of Cardiology- Infarct location

Pain radiating from his jaw to left arm (Indicative of a

heart attack!)

Diagnostic Tests
Electrocardiogram (EKG)- Measures the hearts electrical
activity, strength of electrical signals, pace
Blood Tests- protein
Coronary Angiography- Uses dye to find blockages in the
arteries through showing the inside of the coronary artery
Troponin test- type of blood test, specific protein in the
blood

Relevant Lab data

Abnormally high ALT and AST levels: Normal levels= <35

ALT= 30- 215 U/L

AST= 25- 245 U/L

Dyslipidemia: Low HDL & High LDL: Normal Level HDL= >45M,
Normal Level LDL= <130

HDL= 30-33mg/dL

LDL= 141-160 mg/dL

High troponin I & T levels: Normal levels = <.2

2.1-2.8 U/L

How labs relate to myocardial infarction

High Troponin Levels: Myocardial damage

Protein (found in heart muscle)s released after myocardial

damage & indicative of cardiomyopathy

High ALT & ADT Levels: Liver Function

MI -> Decrease cardiac output -> hepatocellular necrosis

Journal of Angiology. Hepatic dysfunction due to cardiac

diseases

Labs cont.
High LDL & Low HDL Levels

Positive correlation btw elevated LDL cholesterol levels

and the presence of atherosclerosis

Low LDL levels are found to decrease risk of

atherosclerosis and MI

Family history & genetics

How MI Affects Nutrition Status

Dyslipidemia is a contributing factor to MI
AHA 6% saturated fat to reduce LDL cholesterol

Advances in Nutrition Adipose tissue and effect on lipid

response to dietary intervention

Fiber well known to help correct dyslipidemia by

reduction in LDL levels
TLC diet

24-hour recall
Mid Morning Snack: 1 large cinnamon raisin bagel with
1tbsp fat-free cream cheese, 8oz orange juice
Lunch: 1c canned beef soup, sandwich with 4oz roast
beef, lettuce, tomato, dill pickles, 2tsp mayo, 1 apple,
1 c 2% milk
Dinner: 1 lean pork chops(3oz each), 1 large baked
potato, 1 tsp margarine, c green beans, c
coleslaw with salad dressing, 1 slice apple pie
Snack: 1c 2% milk, 1oz pretzels

Analysis of 24 hour recall

Analysis Cont.
Excess total kcals at 2,766kcals
Adequate fiber intake at 26g
High saturated fat intake 11%kcals
Sodium well above recommendation at 4,395m/day!

Estimated Nutrient Needs

Total kcals: 66.5 + (13.8*84.09kg) + (5*177.8cm)(6.76*61)= 1703kcal. 1703kcal * 1.2 activity factor=
2,044kcal
17% Protein: 347kcals. 86g
28% Fat: 575kcals. 64g
55% CHO: 1,130kcals. 282g
Fluid: 30mL/kg= 2,520mL

Pros of the Diet

2% milk
Fruit and vegetable intake
No fried foods
No sweetened beverages

Cons of the diet

High fat!
High fat animal protein
Missing breakfast
Low in vit D

Dietary Suggestion
Weight loss diet
Continue 2% milk
Lower sodium through consumption of low sodium food
i.e low sodium protein, replace canned soup with
homemade soup

Nutrition Care Process

PES Statements:
1.

Excessive saturated fat intake related to large servings of animal

protein as evidence by 24 hour recall and saturated fat representing
11% of calories as compared to references values: total saturated
fat <6% of total kcal

2.

Excessive sodium intake related to intake of canned soup and high

fat animal protein as evidence by sodium intake >4395mg/day as
compared to reference values: <2300mg/day

3.

Physical inactivity related to busy work schedule as evidence by

patient interview

Interventions
Excessive Fat intake: Saturated fat <6% total kcals.
Focus on switching from high fat animal protein to lean
protein
Excessive sodium Intake: Education on label reading,
low sodium cooking to retain palatability
Physical Inactivity: Refer out to physical therapist to
provide exercise regimen that will help recovery from
MI and then aid in weight loss.

Patient Goals
Promote recovery and strength through diet
modifications given by dietitian and physical activity
regimen given by physical therapist
Correct dyslipidemia through lowering saturated fat
intake to promote lowering of low density lipoprotein

Nutrition Prescription
Decrease saturated fat to account for <6% total kcals
and bring total fat intake to 28% of total kcals
Decrease consumption of high sodium foods and bring
sodium intake to <2300mg/day
To promote weight reduction and recovery
participation in physical activity regimen prescribed by
physical therapist

The End
Any Questions?