Patrick Burrows

Prof. Matuszak
KNH 411
9/3/15

Case Study #5 Myocardial Infarction

1. Mr. Klosterman had a myocardial infarction. Explain what

happened to his heart.

When someone experiences a myocardial infarction, commonly known

as a heart attack, the coronary arteries that supply the heart muscle
with oxygenated blood become occluded. When these arteries become
occluded the heart muscle that they supply blood to begin to die
(Conditions We Treat: Myocardial Infarction).

2. Mr. Klostermans chest pain resolved after two sublingual NTG

at 3-minute intervals and 2mgm 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 infarctrelated artery with a near normal flow. A stent was left in place

to stabilize the patient and limit the infarct size. Left

ventricular ejection fraction was normal at 42%, and a
posterobasilar scar was present with hypokinesis. Explain
angioplasty and stent replacement. What is the purpose of this
medical procedure?

Angioplasty is a non-surgical procedure used to open up a narrow or

blocked coronary artery. This is performed by inserting a thin tube
through the artery in the arm of thigh of the patient and then into that
occluded artery. The tube is then opened to create a pathway through
the plaque to allow blood flow to reach the tissue that fell victim to the
infarct. The tube that is inserted into the artery is called a stent. The
overall purpose of this procedure is to restore the blood flow to the
affected heart muscle so that the muscle does not completely die
(What Is Percutaneous Coronary Intervention?).

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 rehabilitation is important for many reasons. Cardiac

rehabilitation will allow Mr. Klosterman to figure out a baseline for

where he currently is with his cardiac health post operation. Cardiac

rehabilitation will also allow Mr. Klosterman to recover to his fullest
capacity while under supervision so that he does not cause
unintentional harm to himself (What is Cardiac Rehabilitation).

4. What risk factors indicated in his medical records can be

addressed through nutrition therapy?

Risk factors indicated in his medical records that can be addressed

through nutrition therapy are: diet, amount of exercise, tobacco use,
and the 26.6 BMI.

5. What are the current recommendations for nutritional intake

during a hospitalization following a myocardial infarction?

Mr. Klosterman is currently on a diet of clear liquids and no caffeine.

Immediately post op this diet will continue for 24 hours. After that he
should move on to soft foods. Depending on his blood pressure sodium
may need to be restricted. After soft foods he should move onto small
meals throughout the day. (Recovering from coronary angioplasty and
stent insertion)

6. What is the healthy weight range for an individual of Mr.

Klostermans height?

Using the Hamwi Method it can be determined that Mr. Klosterman

should weight near 166lbs.

106lbs+(10in x 6lbs)= 166lbs

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.

Miflin-St. Jeor equation

REE = 10 (WT kg)+6.25 (HT cm) 5 (age yrs) + 5
REE= 10(83.91)+6.25(177.8)-5(61)= 1645(1.2 (sedentary))= 1974
kcal/day

According to Advanced Nutrition and Metabolism:

Protein requirement for those 50 and older= 56 g/day protein (RDA)

8. Using Mr. Klostermans 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.

According to Super Tracker Mr. Klosterman consumed approximately

2671 calories. Of those calories 18% came from protein, 47% came
from carbohydrates, and 36% came from fats.

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?

The lab values that are consistent with the MI diagnosis are the
troponin 1, and troponin T. When a myocardial cell dies the troponin
contained within it leaks into the blood stream causing this rise in
levels. The levels are higher on day 2 because the levels continue to
rise and stay high for one to two weeks after the MI (Bolooki, M).

10.

What is abnormal about his lipid profile? Indicate the

abnormal values.

The abnormal values contained in Mr. Klostermans lipid profile are:

Total cholesterol= 235, high
HDL= 30, low

LDL= 160, high

11.

Mr. Klosterman was prescribed the following medications

on discharge. What are the food-medication interactions for

this list of medications?

Medication
Lopressor 50mg daily
Lisinopril 10mg daily

Nitro-Bid 9.0mg twice daily

NTG 0.4mg sl prn chest pain
ASA 81mg daily

12.

Possible Food-Medication
Interactions
Low Sodium/Salt is recommended.
Avoid licorice. (Lee)
Low Sodium/Salt is recommended.
Do not use salt substitute with
potassium, and do not take
potassium supplements. Avoid
licorice. (Lee)
Avoid alcohol. (Moore)
Avoid alcohol. (Moore)
Take with food, water, or milk to
decrease stomach upset. With a
high dose of this drug, one may
need to increase consumption of
vitamin C, vitamin K, and folate.
Limit or avoid products that affect
blood coagulation. (Moore)

You talk with Mr. Klosterman and his wife, a math teacher

at the local high school. They are friendly and seem

cooperative. They both are anxious to learn what they can do
to prevent another heart attack. What questions will you ask
them to assess how to best help them?

What do you already know about nutrition? What do you want to know
more about? Would you be interested in attending culinary classes to
learn new cooking styles? Do you understand the pathophysiology of a
heart attack? Do you know what foods and cooking styles are related
to atherosclerosis?

13.

What other issues might you consider to support the

successful lifestyle changes for Mr. Klosterman?

Three things that could be worked on by the client is to quit smoking,

increase his amount of daily exercise, and to increase not only his
amount of general nutrition education but also his spouses.

14.

From the information gathered within the assessment,

list possible nutrition problems using the correct diagnostic

terms.

Overweight/Obesity
Excessive energy intake

15.

Select two of the identified nutrition problems and

complete a PES statement for each.

Excessive energy intake due to inappropriate calorie intake as

evidenced by excessive amount of calories in clients 24-hour recall.

Overweight due to sedentary lifestyle as evidenced by clients BMI of

26.6.

16.

For each of the PES statements you have written,

establish an ideal goal (based on the signs and symptoms) and

an appropriate intervention (based on etiology).

An ideal goal would be to reduce the amount of calories consumed

through education and meal planning.

An ideal goal to reduce the patients BMI would be to attend cardiac

rehab and when he is cleared to exercise, have him walk longer.

17.

Mr. Klosterman and his wife ask about supplements. My

roommate here at the hospital told me I should be taking fish

oil pills. What does research say about omega-3-fatty acid
supplementation for this patient?

Some research has demonstrated reduced mortality with increased

intakes od Omega-3 lipids. There have also been other studies with

mixed results. The AHA recommends that patients that suffer from CHD
consume 1g daily. (pg. 319)

18.

What would you want to assess in three to four weeks

when he and his wife return for additional counseling.

When Mr. Klosterman and his wife return in three to four weeks I would
want to assess his lab values again to see if things are returning to a
normal level. I would also want to assess his cessation of smoking, his
BMI, as well as how his increased activity level is.

References
Bolooki, M. (n.d.). Acute Myocardial Infarction. Retrieved September 1, 2015,
from
http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/car
diology/acute-myocardial-infarction/Default.htm
Conditions We Treat: Myocardial Infarction (Heart Attack). (n.d.). Retrieved
September 3, 2015, from

http://www.hopkinsmedicine.org/heart_vascular_institute/conditions_treatme
nts/conditions/myocardial_infarction.html
Gropper, S., & Smith, J. (2009). Advanced nutrition and human metabolism
(5th ed.). Australia: Wadsworth/Cengage Learning.
Lee,RD, A. (n.d.). Food and Medication Interactions. Retrieved September 3,
2015, from http://www.seniorconnection.org/pdfs/FD-handout1.pdf
Moore, R. (2013, September 1). Nutrient-Drug Interactions and Food.
Retrieved September 3, 2015, from
http://www.ext.colostate.edu/pubs/foodnut/09361.html
What Is Cardiac Rehabilitation? (n.d.). Retrieved September 1, 2015, from
http://www.nhlbi.nih.gov/health/health-topics/topics/rehab/
Nelms, M. (2011). Nutrition therapy and pathophysiology (2nd ed.). Belmont,
CA: Wadsworth, Cengage Learning.
Recovering from coronary angioplasty and stent insertion. (2005). Retrieved
September 1, 2015, from http://www.newcastlehospitals.org.uk/downloads/Governors Papers Ad
Hoc/Recovering_from_Coronary_Angioplasty_and_Stent_Insertion.pdf
What Is Percutaneous Coronary Intervention? (n.d.). Retrieved September 3,
2015, from http://www.nhlbi.nih.gov/health/health-topics/topics/angioplasty/