Sheeba Sherin Charles
Dietitian, Kauvery Hospital, Heart city, Trichy
Correspondence: dietary.khc@kauveryhospitals.com
Introduction
Coronary artery disease (CAD) is a narrowing or blockage of the coronary arteries, which supply oxygen-rich blood to the heart. This happens because, over time, plaque (including cholesterol) buildup in these arteries limits how much blood can reach the heart muscle. Plaques are caused by a build-up of fatty material within the walls of the arteries. This build-up narrows the inside of the arteries, limiting the supply of oxygen-rich blood to the heart muscle. Other names for CAD include coronary heart disease (CHD) and ischemic heart disease. It’s also what most people mean when they use the general term “heart disease.”
Symptoms of Coronary Artery Disease May Include
- Chest pain
- Fatigue (severe tiredness)
- Palpitations
- Abnormal heart rhythms
- Shortness of breath
- Swelling in the hands and feet
- Indigestion
Causes of Coronary Artery Disease
- This plaque is primarily made of cholesterol. Plaque accumulation can be accelerated by smoking, high blood pressure, elevated cholesterol, and diabetes.
- Patients are also at higher risk for plaque development if they are older (greater than 45 years for men and 55 years for women), or if they have a positive family history for early heart artery disease.
- The atherosclerotic process causes significant narrowing in one or more coronary arteries. When coronary arteries narrow more than 50–70%, the blood supply beyond the plaque becomes inadequate to meet the increased oxygen demand during exercise. The heart muscle in the territory of these arteries becomes starved of oxygen (ischemic).
- Patients often experience chest pain (angina) when the blood oxygen supply cannot keep up with demand.
- Up to 25% of patients experience no chest pain at all despite documented lack of adequate blood and oxygen supply.
- These patients have silent angina, and have the same risk of heart attack as those with angina.
- When a blood clot (thrombus) forms on top of this plaque, the artery becomes completely blocked causing a heart attack.
- When arteries are narrowed in excess of 90–99%, patients often have accelerated angina or angina at rest (unstable angina). Unstable angina can also occur due to intermittent blockage of an artery by a thrombus that eventually is dissolved by the body’s own protective clot-dissolving system.
Diagnosis
The electrocardiogram (ECG) is a recording of the electrical activity of the heart, and can demonstrate signs of oxygen starvation of the heart (ischemia) or heart attack.
Often, the resting ECG is normal in patients with coronary artery disease and angina. Exercise treadmill tests are useful screening tests for patients with a moderate likelihood of significant coronary artery disease (CAD) and a normal resting ECG.
These stress tests are about 60–70% accurate in diagnosing significant CAD.
Cardiac catheterization with angiography (coronary arteriography) is the most accurate test to detect coronary artery narrowing. Small hollow plastic tubes (catheters) are advanced under X-ray guidance to the openings of the two main heart arteries (left and right). Iodine contrast dye, is then injected into the arteries while an X-ray video is recorded.
CT Angiography is also available. This procedure uses powerful X-ray methods to visualize the arteries to the heart.
Prevention
- Eat a healthy, balanced diet.
- Be more physically active.
- Keep to a healthy weight.
- Give up smoking.
- Reduce your alcohol consumption.
- Keep your blood pressure under control.
- Keep your diabetes under control.
- Do the health check on a yearly basis.
- Improve sleep health.
Case Report
CAD, Admitted for CABG
Risk factors: T2DM, HTN
Plan: Plan for CABG
Biochemical Value – 7 Days
| Date | Hemoglobin | Urea | Creatinine | Sodium | Potassium |
| Day-1 | 11.8 | 30.6 | 0.5 | 130.5 | 3.4 |
| Day-2 | - | - | - | - | - |
| Day-3 | 10.7 | 44.8 | 1.0 | - | 4.0 |
| Day-4 | - | - | - | 136.2 | 3.8 |
| Day-5 | 11.2 | 35.2 | 0.8 | 135.8 | 3.1 |
| Day-6 | 11.3 | 44.5 | 1.0 | 140.3 | 3.3 |
| Day-7 | 11.5 | 30.2 | 0.8 | 138.5 | 3.5 |
Nutritional assessment
For 57 years old male patient
Anthropometric measurements
| Height | 170 cm |
| Weight | 68 kg |
| BMI | 23.5g/m2 (Normal weight) |
| IBW | 70 kg |
Diet History
| Diet history | Non Vegetarian |
| Food Allergy | Bitter gourd |
| Appetite | Normal |
| GI Symptoms | Nil |
| Clinical Signs & Symptoms | Nil |
| Weight changes | 2kg (1Month) |
Case Presentation
- A 57-year-old male was admitted to the hospital with chest pain. The patient was on medication for uncontrolled DM and hypertension. Patient conscious, A febrile pulse rate of 80/min.
- The patient’s Anthropometric measurements were height-170 cm, weight- 68 kg, Body mass index (BMI) – 23kg/m2, and Ideal body weight – 70kg. Patient was normal weight. Patient biochemical values were normal.
- During the hospital stay, nutrition management was planned according to the health condition of the patient. Followed by the patient’s 24hr dietary recall. It showed he had consumed adequate calorie, moderate carbs, low fat, low salt, and a regular diet that contains 1650 kcal, 65 gm of protein, and 27 gm of fat per day. This diet was given by the hospital under dietary guidance. Patient intake and urine output were normal.
Patient Hospitalized (Post – Op) Diet
| Day 1 | Clear liquid diet |
| Day 2 | Liquid diet |
| Day 3 | Semi solid diet |
| Day-4 | Soft diet |
Day 1- Clear Liquid Diet
| Time | Clear liquid diet |
| 12 pm | Mosambi juice |
| 2 pm | Whey water |
| 4 pm | Dhal soup (clear) |
| 6 pm | Mosambi juice |
| 8 pm | Veg soup (clear) |
| 10 pm | Whey water |
Day 2- Normal Liquid Diet
| Time | Liquid diet |
| 6 am | Protein Supplement |
| 8 am | Sathumavu Kanji |
| 10 am | Mosambi Juice |
| 12 pm | Dhal Soup (Stained) |
| 2 pm | Rice Kanji |
| 4 pm | Protein Supplement |
| 6 pm | Protein Supplement |
| 8 pm | Wheat rava kanji |
| 10 pm | Protein Supplement |
Day -3 Semisolid Diet
| Time | Semisolid Diet |
| 6 am | Protein Supplement |
| 8 am | Idiyappam + Samabar + Chutney |
| 10 am | Protein Supplement |
| 1 pm | Rasam rice + Veg kootu + Veg poriyal + 1 egg white |
| 4 pm | Protein Supplement |
| 6 pm | Protein Supplement |
| 7:45pm | Idly + Sambar + Chutney |
| 9pm | Protein Supplement |
Day 4 – Soft Diet
| Time | Soft Diet |
| 6 am | Protein Supplement |
| 8 am | Uthappam + Sambar + Chutney |
| 10 am | Apple Fruit + Protein Supplement |
| 1 pm | Double boiled rice + Veg Kootu + Veg Poriyal + 2 Egg white |
| 4 pm | Sundal (Boiled) |
| 6 pm | Protein Supplement |
| 8 pm | Wheat Dosa + Sambar + Chutney |
| 10 pm | Protein Supplement |
Nutritional Requirements
| Diet | Calorie (kcal) | Protein (g) | Fat (g) |
| Clear liquid diet (6 feeds/2 hr) | 620 | - | - |
| Liquid diet (9 feeds/2 hr) | 1420 | 55 | 24 |
| Semi solid diet + protein supplement | 1580 | 64 | 27 |
| Soft diet + protein supplement | 1754 | 71 | 30 |
| Calorie | 1754kcal/25.8/kg |
| Protein | 71g/1.1g/kg |
| Fat | 30g/0.45g/kg |
Principles of Diet
- Adequate calorie
- High protein
- Moderate carbohydrate
- High fibre
- Iron rich
- Low fat
- Vitamins and Minerals – as per RDA
Dietary guidelines
Foods to Be Included
Millets and cereals: Wholegrain cereals contain many different phytochemicals which have been linked to significant health benefits. These phytochemicals include: lignans which can lower the risk of coronary artery disease.
Pulses and legumes: Pulses are one of the highest fiber foods just one portion of pulses provides about a third of the fiber you need for the entire day. That means they can help lower your risk of heart disease, stroke, type 2 diabetes mellitus and bowel cancer.
Green leafy vegetables: Adding greens to your diet can color your plate and nourish your heart. According to a study from the International Journal of Epidemiology, eating green leafy and cruciferous vegetables helps reduce risk of cardiovascular disease. That’s because they are extremely low in fat, calories and high in dietary fiber. They also contain folic acid, magnesium, calcium, potassium, etc.
Fruits and vegetables: Many vegetables and fruit are particularly rich in vitamin C and in beta-carotene, which is a form of vitamin A. These work as antioxidants in your body, helping to slow down or prevent atherosclerosis by reducing the buildup of plaque from cholesterol and other substances in the arteries.
Milk products: Skimmed Milk or low fat milk, Buttermilk.
Lean meats: Such as country chicken, chicken (without skin).
Fish: High in omega-3 fatty acids (salmon, sardines, tuna, and trout).
Eggs white: 2 numbers per day.
Nuts: Almonds (soaked), Groundnuts (boiled), Walnuts.
Oil: 2-3 tsp (15 ml) (Ground nut oil, Sesame oil, Rice brand oil, Vegetable oil, Corn oil).
Sugars: 2-3 tsp (15gm) (Brown sugar, Jaggery).
Water: Drink enough amount of water in a day, 8-10 glass (2 liters).
Foods to be avoided
- Avoid refined foods and their products like white Rava, maida, Noodles, Pasta.
- Avoid fried foods and junk foods.
- Avoid Bakery Products like Puffs, Chips, and cakes.
- Avoid caffeine and alcohol as they make you dehydrated.
- Avoid frozen and processed foods. Avoid red meat, oily and fat foods.
- Limit added sugars.
- Quit smoking.
References
- Davies MK, Hollman A. History of cardiac surgery. Heart. 2002.
- Sims FH. A comparison of coronary and internal mammary arteries and implications of the results in the etiology of arteriosclerosis American Heart Journal. 1983.
- Balacumaraswami L, Taggart DP. Intra operative imaging techniques to assess coronary artery bypass graft patency. Annals of Thoracic Surgery. 2007.
Sheeba Sherin Charles
Dietitian