Question

Cardiovascular Case Study

M.R. is a 63 year-old Caucasian male who was admitted for an angioplasty with stent placement is his right coronary artery. He is an insurance agent and has been working his normal hours.  Does not indicate any additional physical activity above normal daily activities. Ht. 5’9” Wt; 240# No recent weight gain or loss

Blood pressure: 160/100 mm Hg

LDL 160 mg/dl  HDL 35 mg/dl  Blood glucose:  240 mg/dl

Medical Hx:  Type 2 diabetes

Family Hx: Father died at the age of 50 due to a myocardial infarction

Social Hx: smokes 1 pack of cigarettes a day; no exercise

Physical exam:  no edema, ascites, muscle  or fat loss

Medications: none

Diet Hx: breakfast: toast or muffin with eggs and glass of whole milk   Lunch: 2 meat sandwiches, oreos and whole milk  Dinner: meat with bread and butter   Snack: low sugar ice cream or crackers with cheese

GI Hx:  no history of nausea/vomiting/diarrhea/constipation

1.Using SGA what is his nutritional status?

2.List his modifiable and non-modifiable risk factors.

3.How does smoking, high LDLs and diabetes contribute to atherosclerosis?

4.Calcuate his BMI.

5.How does his cardiovascular labs compare to the desirable levels?

6.What are his sources of saturated fatty acids?

7.What lifestyle changes would you suggest to him now that his artery is no longer blocked? (Think DASH diet)

Answer 1

Answer

1.The patient is a well nourished one as defined by subjective global category assessment

.It falls under the category of 0-1 i,e SGA A

(Nutritional assessment measure (SGA)can predict nutritionally aassociated complications Including malnutrition.The higher score predicts more malnutrition)

2.The modifiable risk factor is smoking and the sedentary habit or no or minimal physical activity

The non modifiable risk factor is Diabetis and family history of Myocardial infarction.

3.Actually in diabetes, there is a major change in the pathophysiology of our system and that occur in molecular level. Here platelets ,soluble clotting factors and the optimal balance of prostacyclin-thromboxane is altered. Alteration of blood pressure regulation due to changes in arterial smooth muscle cell metabolism and proliferation. These all are the risk factors of atherosclerosis.

3. Role of LDL…….. The pathology underlying the atherosclerosis is endothelial dysfunction and ultimately smooth muscle cell proliferation. On arterial endothelial cell lining injury, modified Lipoproteins incite infiltration of inflammatory cells e.g Monocytes ,macrophages into subendothelial cell lining. Foamy cells are formed due to engulfing modified lipoproteins LDL, apolipoproteins inside them and these are called foamy cells.We recognize this as the marker of atherosclerosis . There are other factors also which together promote smooth muscle cell proliferation and endothe;ial cell damage.promoting atherosclerosis.

3.Smoking causes platelet dysfunction, serum lipid alteration, vascular endothelial inflammation by oxidative stress, and ultimately it is one of the most important risk factors in coronary heart disease and therfore in atherosclerosis

4.   The formula is BMI = kg/m2 where kg is a person's weight in kilograms and m2 is his height in metres squared.

Here it is 240/5.9²=78.1

He is a obese man