CASE STUDY 2

CARDIOVASCULAR DISEASE
CORONARY ARTERY DISEASE(CAD)
A narrowing of the coronary arteries that prevents adequate blood supply to the
heart muscle is called coronary artery disease. Usually caused by atherosclerosis , it may
progress to the point where the heart muscle is damage may result in infarction,
arrhythmias,and heart failure.
If the heart does not get enough blood, it cannot get the oxygen and nutrients it needs
to work properly. This can cause chest pain (angina) or a heart attack.
PULMONARY OEDEMA
A condition caused by excess fluid in the lungs. Pulmonary oedema is usually by a
heart condition. Other causes include pneumonia , exposure to certain toxins and drugs, and
being at high elevations.
RISK FACTORS OF CAD
MODIFIABLE
 High blood cholesterol level
 Cigarette smoking, tobacco use
 Hypertension
 Diabetes mellitus
 Lack of estrogen in women
 Physical inactivity
 Obesity
NON MODIFIABLE
 Family history of CAD
 Increasing age
 Gender
 High stress
 Unhealthy diet
SYMPTOMS
 Shortness of breath(dyspnea)
 Chest pain(angina pectoris)
 Fatigue
SYMPTOMS OF CAD
 Hypertension
 Myocardial infarction
 Diaphoresis
 ECG changes
 Dysarrithmias
 Chest heaviness
SYMPTOMS OF PULMONARY OEDEMA
 Fast breathing , rapid breathing
 Wheezing
 Sweating
 Coughing
 Water retention
CAUSES
 Smoking
 High blood pressure
 High cholesterol
 Diabetes or insulin resistance
 Sedentary lifestyle
 Congestive heart failure
 Other heart disease
 Pneumonia
 Kidney failure
 Severe trauma
 Major injury
 Lung damage caused by inhalation of toxins
COMPLICATIONS
 Chest pain ( angina)
 Heart attach
 Heart failure
 Abnormal heart rhythm (arrtythmia)
 Sudden death
 Related arterial disease
  Breathing difficulty
 Swelling of legs, feet and abdomen
 Buildup of fluid in the membranes that surround your lungs (pleural effusion)
 Congestion and swelling of liver
DIETARY MANAGEMENT
OBJECTIVE
 Maximum rest to the heart
 Maintenance of good nutrition
 Acceptability of the programme
PRINCIPLES OF DIET
Diet therapy remains the first line of treatment for patient with high blood cholesterol levels.
Low calories, low fat particularly low saturated fat, low cholesterol high in PUFA with
omega3 to omega 6 ratio 10:1 , low carbohydrates and normal protein, mineral and vitamins
are suggested. High fiber diet with increased amount of antioxidants is also recommended.
FOODS TO BE INCLUDED
 Fruits & vegetables
 Green leafy vegetables
 High fiber
 Omega 3,omega6 fatty acids
 Vegetable oil PUFA
 Small quantities of almonds & walnuts
 Skimmed milk
 Carotenoids & vitamin E rich foods
 Soyabean , fenugreek, garlic, onion, flax, oats and turmeric can be included
FOODS TO BE AVOIDED
 Alcohol
 Deep fried foods
 Processed foods
 Red meat
 Salt
 Coconut
 Carbonated beverages
 Sugar based products
 Saturated fat
 Egg yolk

GENERAL INFORMATION
Name : Krishna.T
Gender : Male
Age : 55
Religion : Hindu
Occupation : IT professional
Date of admission :

HOSPITAL DETAILS
MRD No :
Ward No :

MEDICAL HISTORY
Past Medical History : Hyper Tension
Present Complaints : Chest pain and breathing difficulties
Diagnosis : Coronary Artery Disease, pulmonary oedema

NUTRITIONAL STATUS EVALUATION 1] Anthropometric Assessment

PARAMETERS ASSESSMENT
Height 160
Weight 60
BMI 60
IBW 23.4kg/m²(Normal)

NUTRITIONAL SCREENING ON ADMISSION

• Social history : occasional alcohol drinking and smoking
• Family history : no one had any form of heart disease
• Diet history : normal diet and Non vegetarian
Allergy : No food allergy
Activity : Doesn’t perform any exercise
Sleep pattern : Irregular sleep patterns
2] Biochemical Assessment

NAME OF THE TEST RESULT

Haemoglobin 9.2Gms/dl
Blood sugar(random) 95
HbA1C 6.0%
Blood urea 19.0 Mg/dl
Serum ceratinine 1.0Mg/dl
Sodium 138mEq
Potassium 4.2 mEq

3] Biophysical Assessment
Blood pressure :120/80
Pulse rate :90/min
Respiration :22/min
EF(Ejection fraction) :60%
Temperature :98.6oF
Total intake :1400ml
Total output :1700 ml

4] Clinical Assessment
ORGANS OBSERVATION
General Apperance Normal
Eye Normal
Mouth Normal

Behavior
Normal
Ear Normal
Tongue Normal
Nail Normal

6] Dietary Assessment Food Habit :Non Vegetarian

Food Allergy : No
FOOD FREQUENCY RECORD
FOODITEM DAILY WEEKLY MONTHLY OCCASSIONALLY
Cereals 

Pulses 
GLV 

Roots &Tubers 

Milk
Fats &oils 

Other Vegetables 

Fried foods 

Junk foods 

Meat/Egg/Fish 

Fruits
Sugar and jiggery 

Others 

24 HOUR RECALL
TIMING FOODITEMS QUANTITY

6.00am Coffee 100ml

8.00am Idly 2 no’s

Tomato chutney ¼ cup

1.00pm Rice 1 cup

Sambar ¼ cup

Rasam ¼ cup

4.00pm Tea 100ml

7.00pm Dosa 2 no’s

Sambar ¼ cup

CALCULATION
FOODITEM QUANTIT ENERGY(kcal PROTEIN(gm CHO(gm FAT(gm
S Y ) ) ) )
Coffee 100ml 105 3.2 14 4

Idly 2 no’s 170 1.6 20 -

Tomato ¼ cup 44.4 0.45 1.3 4.16

chutney

Rice 1 cup 85 1.6 20 -

Sambar ¼ cup 110 6.6 20 -

Rasam ¼ cup 25.3 1.6 20 -

Tea 100ml 105 3.2 14 4

Dosa 2 no’s 170 6.6 20 -

Sambar ¼ cup 110 6.6 20 -

Total 924.7 31.45 149.3 12.16

APROXIMATELY NUTRITIVE VALUE

• Energy:924.7kcal
• Fat:12.16gm
• Carbohydrates:149.3gm
• Protien:31.45gm

MEDICATIONS
DRUGS DOSAGE
T. ECOSPRIN (150mg) 1-1-0-1
T.Cefindir (300mg) 1-0-0-1
T.Dolo(650mg) 1-1-0-1
T.Anxit 1-0-0-1

NUTRITIONAL STATUS OF THE PATIENT

➢ DIET PRESCRIBED: Oral- low fat normal diet
➢ PRINCIPLE OF DIET: Normal calories and protein, low fat, high fibre and liberal
vitamins and minerals diet
DIET ORDER
DATE DIET ORDER
FIRST DAY- MENU

SECOND DAY- MENU

THIRD DAY- MENU

THREE DAYS MENU

FIRST DAY- MENU

TIMING FOOD ITEMS QUANTITY

6.00am Coffee 100ml

8.00am Idly 3 no’s

Sambar ¼ cup

10.00pm vegetable soup 100ml

1.00pm Rice 1 cup

Sambar ¼ cup

Rasam ¼ cup

Egg white 1nos

4.00pm Green gram sundal 50g

8.00pm Chapatti 3no’s

Tomato chutney ¼ cup

10.00pm Skimmed milk 100 ml

APPROXIMATE NUTRITIVE VALUE

FOOD QTY ENERGY(kcal) PROTEIN(gm) CHO(gm) FAT(gm)
ITEMS

Coffee 100ml 105 3.2 14 4

Idly 3 no’s 255 4.8 60 -

Sambar ¼ cup 7.5 0.65 1 0.1

Veg soup 100ml 60 2 12 -

Rice 1 cup 255 4.8 60 -

Sambar ¼ cup 7.5 0.65 1 0.1

Rasam ¼ cup 56.6 0.62 13.48 0.02

Egg white 1nos 65 6.6 - 4

Green gram 50g 12 0.22 2.65 0.05

sundal

Chapatti 3no’s 255 9 53 -

Tomato ¼ cup 85 3 18 -
chutney

Skimmed 100ml 65 3.2 4 2

milk

TOTAL 1228.6 46.19 239.13 10.27

TOTAL INTAKE OF NUTRIENTS

Energy : 1228.6kcal

Protein : 46.19gm

CHO : 239.13gm

Fat : 10.27gm

SECOND DAY- MENU

TIMING FOOD ITEMS QUANTITY

6.00am Milk 100ml

8.00am Idly 3 no’s

Onion Sambar ¼ cup

 Tomato chutney ¼ cup

10.00am Pomegranate juice 100ml

1.00pm Curd rice 1cup

Potato porriyal ¼ cup

4.00pm Channa boiled 50g

8.00pm Chapatti 2no’s

Vegetable kuruma ¼ cup

10.00pm Milk 100ml

APPROXIMATE NUTRITIVE VALUE

FOOD ITEMS QTY ENERGY(kcal PROTEIN(gm) CHO FAT (gm)

) (gm)

Milk 100ml 130 6.4 8 8

Idly 3no’s 255 3.2 40 -

Onion Sambar ¼ cup 135 7.6 25 -

Tomato ¼ cup 30 1 6 -
chutney

Pomegranate 100ml 40 - 10 -
juice

Curd rice 1cup 255 6.35 61.5 2

Potato porriyal ¼ cup 85 1.6 20 -

Channa boiled 50 gm 85 5.6 15 -

Chapatti 2no’s 170 6 36 -

Vegetable ¼ cup 40 1.5 8 -

kuruma

Milk 100ml 130 6.4 8 8

TOTAL 1355 45.65 237.5 18

TOTAL INTAKE OF NUTRIENTS:

Energy : 1355kcal
Protein : 45.65gm

CHO : 237.5gm

Fat : 18 gm

THIRD DAY MENU

TIMING FOOD MENU QUANTITY

6.00am Coffee 100ml

8.00am Idly 2no’s

Paruppu chutney ¼ cup

Dhal sambar ¼ cup

10.00am Orange juice 150ml

1.00pm thinai Rice, 1cup

avarakkai sambar, ¼ cup

pepper Rasam, ¼ cup

kovakai porriyal, ¼ cup

curd ¼ cup

4.00pm Black Channa sundal 100g

8.00pm Chapatti 2no’s,

Veg kuruma, ¼ cup

Onion chutney ¼ cup

APPROXIMATE NUTRITIVE VALUE:

FOOD ITEMS QTY ENERGY PRITEIN (gm) CHO (gm) FAT (gm)
(kcal)

Coffee 100ml 65 3.2 4 4

Idly 2no’s 170 3.2 40 -

Dhal sambar ¼ cup 110 6.6 12.5 -

 ParuppuChutney ¼ cup 85 5.6 15 -

Orange juice 150ml 13.5 0.3 2.85 0.15

Thinai rice 1cup 248 9.2 45.6 2.05

Avarakkaisamba ¼ cup 55 1.5 8 -

r

Kovakai porriyal ¼ cup 12.6 0.84 2.17 0.07

Pepper Rasam ¼ cup 28.3 1.5 1.3 -

Curd ¼ cup 60 3.1 3.0 4.8

Black Channa 100g 340 22.4 60 -

Sundal

Chapatti 2no’s 170 6 36 -

Veg kuruma ¼ cup 40 1.5 8 -

Onion chutney ¼ cup 50 2 10 -

Total 1447.4 82.78 248.42 11.07

TOTAL INTAKE OF NUTRIENTS:

Energy : 1447.4kcal

Protein : 82.78 gm

Carbohydrate : 248.42gm

Fat : 11.07gm

SUGGESTED MENU:

TIMINGS MENU QUANTITY

EARLY MORNING SKIMMED MILK 100ml

BREAKFAST RAGI IDIAPPAM 3 nos

VEG KURUMA 50g

 BRINJAL SAMBAR 50g

APPLE 100g

MID MORNING POMEGRANATE 1 cup

LUNCH BROWN RICE 100g

LADYSFINGER 1 cup
KOLAMBU

BEANS PORIYAL 1 cup

RASAM 1cup

BUTTERMILK 150ml

EVENING GREENGRAM (BOILED) 1 cup

DINNER KAMBU DOSA 3 nos

ONION CHUTNEY 1 cup

RIDEGOURD CHUTNEY 1 cup

SCRAMBLED EGG 1 cup

WHITE

BED TIME SKIMMEDMILK WITH 100ml

GINGER

CALCULATION:

FOOD ITEMS INGREDIENTS AMOUN ENERGY[ CHO[g] PROTEIN FAT[g]

T kcal] [g]

RAGI RAGI 80g 262.4 57.8 5.84 1.04

IDIYAPPAM

VEG KURUMA ONION 10g 5 1.26 0.18 0.01

 TOMATO 10g 2 0.36 0.09 0.02

BEANS 5g 7.9 1.49 0.37 0.05

PEAS 5g 4.65 0.795 0.36 0.05

CARROT 5g 2.15 0.53 0.045 0.01

RADDISH 5g 1.6 0.34 0.03 0.015

BRINJAL REDGRAM DHAL 25g 83.75 14.4 5.575 0.425

SAMBHAR

ONION 10g 5 1.26 0.18 0.01

BRINJAL 10g 2.4 0.4 0.14 0.03

TOMATO 5g 1 0.18 0.045 0.01

BUTTERMILK BUTTERMILK 150ml 22.5 0.75 1.2 1.65

APPLE APPLE 100g 59 13.4 0.2 0.5

BROWN RICE VARAGU 100g 309 65.9 8.3 1.4

LADYSFINGER LADYSFINGER 15g 5.25 0.96 0.285 0.105

KOLAMBU

ONION 15g 7.5 1.665 0.18 0.015

POMEGRANATE POMEGRANATE 100g 65 14.5 1.6 0.6

BEANS PORIYAL BEANS 15g 23.7 4.47 1.11 0.15

ONION 15g 2.5 0.63 0.09 0.005

RASAM TOMATO 15g 3 0.54 0.135 0.03

GARLIC 3g 4.35 0.89 0.189 0.003

SCRAMBLED EGG WHITE 1 CUP 65 - 6.6 4

EGG WHITE

GREENGRAM GREENGRAM DHAL 25g 87.00 14.97 6.125 0.3

DHAL (BOILED)

KAMBU DOSA KAMBU 30g 108.3 20.25 3.48 1.5

 PARBOILED RICE 30g 103.8 23.7 1.92 0.12

BLACK GRAM 15g 52.05 8.94 3.60 0.21

ONION ONION 1/4 cup 50 8 6 -

CHUTNEY

RIDGE GOURD RIDGE GOURD 20g 8.8 1.26 0.66 0.12

CHUTNEY

ONION 10g 5 1.26 0.18 0.01

SKIMMED MILK SKIMMED MILK 200ml 58 9.2 5.00 0.2

GINGER GISSNGER 2g 1.34 0.246 0.046 0.018

TOTAL 1436.94 270.27 59.755 14.786

T
ENERGY 1436.94kcal
CARBOHYDRATE 270.27g
PROTEIN 59.755g
FAT 14.786g

Summary:
The patient Krishna.T was 55 years old admitted in the hospital with the present complaints
of chest pain, breathing difficulty. He has the past history of hypertension. The BMI (23.4)
shows that the patient is normal. The biochemical assessment shows that the urea level is
high to normal range. The clinical assessment shows that the patient has no significant
changes. On assessing the dietary habits, the calorie intake is low to normal requirements.
The food frequency shows that the patient's diet include all the food groups. On the
diagnosis of the disease and nutritional assessment, the patient was given drug and dietary
treatment. Drugs were prescribed by the physician and diet order prescribed by the
dietitian. Low fat normal diet has been prescribed to the patient.