Atrial Fibrillation

The heart is a muscle responsible for the circulation of blood through the body which are

connected by electrical signs from the beating of the heart. When electrical signs are disrupted

atrial fibrillation or atrial flutter occur. With atrial fibrillation electrical signs are sent too quickly

to the upper chamber of the heart causing fast contractions. This can cause stimulation in the

heart ventricles making them pump at a faster and less efficient rate. The irregular rhythm of the

upper and lower heart chambers cause atrial fibrillation. When atrial fibrillation occurs the atria

cannot completely pump blood onto the ventricles which eventually cause blood stagnations or

blood clots. When the clots breakdown they eventually work their way through the blood stream

where smaller arteries can become blocked. If this happens in the brain it causes a stroke.

James at the time of being diagnosed with atrial fibrillation is a white 64 year old male, 57 and

weighing 215 pounds. He lives at home with his wife and youngest daughter. He does not eat a

healthy breakfast (donut and coffee from the gas station) takes a sandwich and fruit for lunch and

eats a home cooked meal every evening. He was admitted to the hospital for routine knee

replacement surgery. His primary health care physician gave him medical clearance for the knee

replacement surgery, as the past signs of a heart condition that had been noted in his medical

chart had disregarded. Two days after his surgery he was going to be discharged but began

having heart populations among other signs of a heart condition .Two days later he had heart

surgery, the diagnosis being he had a weak heart and atrial fibrillation, both life threatening. He

was told the knee surgery saved his life as the signs and symptoms he had had previous to the

knee surgery had been dismissed as nothing to worry about.

Changes were now being made in order for him to remain healthy. Besides the medication he

was to take he was to reduce sodium intake and eat minimum foods with large amounts of
potassium and he was to walk at least one mile if not more on a daily basis. The first two years

he lost a little over fifty pounds and was in and out of the hospital due to irregular heart beat

from either eating too much sodium or medication reactions. It has been a little over two years he

has a clean bill of health, has gained all and a little more of his weight back, no longer walks a

mile and does not understand that just taking his medication is not the only solution to living a

little longer with atrial fibrillation.

A plan of action was needed to get James back on track as it had been over a year since having

an attack of any sort with his heart and he was once again comfortable with his life not taking

into consideration that he has gained an excessive amount of weight meaning he is not

nutritionally knowledgeable

At first glimpse I noted that he was in the group of aging persons who are polypharmacy, James

is taking nine different medications in order to help maintain a healthy heart. Three of his

medications are statins this means that there could be an adverse reaction if consumed with

grapefruit juice or licorices. Grapefruit juice and licorice contain a chemical naringenin which

effects how statins are absorbed in the blood, meaning the medications that react with this could

stay in the bloodstream for too long or too short of a period and the side effects could be deadly.

Other medication include diuretics, Digoxin (for irregular heartbeats), allopurinol an anti-

coagulant which needs plenty of fluids and can deplete iron and cause kidney stones with too

much vitamin C. Some of his medications deplete potassium, magnesium and sodium but he is

taking a medication (Lisinopril) that contains iron and zinc. With the amount of medications he

is taking I would not suggest any vitamin or mineral supplements even using recommended

guidelines. At one point he was taking centrum on a daily basis but lab reports indicated that his

potassium levels were too high and he could no longer take that particular vitamin supplement,
At a glimce a better meal plan with foods that include natural essential vitamins and minerals

would be much better for him as he is at risk of taking any other over the counter mineral or

vitamin supplement due to adverse reactions with the other medications being taken.

According to his body mass index he is over his BMI is 35.2 which puts him in a category of

being obese. His nutritional needs according to Harris Benedict equation are as follows:

66.5+13.8*102+5*170-6.8*66=1815 kcals daily

Out of the 1815 kcals he needs 204 to 294 grams of carbohydrates, 45 to 158 grams of protein

and 40 to 70 grams of fat on a daily basis.

He needs to consume at least 1815ml of fluids on a daily basis due to some of his medications in

order to keep his body hydrated.

A diet program needs to be set up for James not just because of his heart condition but because

of his age and his weight. He is susceptible to other older age diseases. If he can get a good

nutritional program and add a little dailty exercise he would be a little healthier.

He stated to me that he works from 6 am until 5pm comes home eats dinner and automatically

lays down. His weekends consist of letting his dog out to run for about an hour, eating and laying

down to watch television. His life style is very sedentary. He does go hunting in the fall for about

a week but admitted that there was a lot of very unhealthy eating that happens during that time.

He claims his wife tries to make light meals for dinner as everyone get home at rather late, but on

the weekend he consumes a somewhat healthy dinner at a decent time. Asking him about the

snacks he eats between meals his response was cookies, muffins cakes basically anything that is

sweet. He keeps some fruit around the house but that is for the days he works. He also stated that

he is too tired to exercise or just does not have the time.

It is necessary for James to want to change his habits beginning with a different diet. His

sedentary life style could be from being overweight, which makes a person feel sluggish and

fatigued. He stated his wife used to be on him about going to exercise on a daily basis but that

soon became tiresome for him, he claims that she went and bought him an exercise bicycle for

the home so he would exercise o it but stated he has never touched it.

Persons over the age of 60 are susceptible to weight gain and sedentary lives if not motivated

mostly because of being set in their ways. James has been a junk food junkie all of his life and

has always been a little over weight. With him becoming set in his ways lying down after eating,

doing basically nothing during the weekends has become his life style and it needs to change in

order for him to live a healthier life. Exercise is important it takes a lot of exercise in order to

lose weight but for James the most important aspect of exercising is to get his heart stronger. He

can do simple things such as during his lunch break take a walk around Meijer or Walmart which

are nearby his place of work he does not necessarily have to go to the gym with his wife in the

evenings but it would be in his best interest to do so. On the weekends when he goes to Sams

club instead of just running in to get the necessitates he can walk around for a little longer. Little

things add up if he realized that he may have a clean bill of health it is just for now. He has

persistent afib and the only thing as of right now that are keeping him healthy are his

medications.

It has been stated by the Journal of American Medical association it takes 35oo calories to lose

one pound that would mean cutting down caloric intake of 500 kcals a day in order to lose one

pound a week. Cutting down even 100 calories a day would be a good start to losing weight. If

James cut down or even swopped out his cookies muffins and other sweet foods he is consuming

for fruits and vegetables this would help him at beginning to eat a little healthier.
Learning how to eat healthier is very difficult. Mostly because it is time consuming and takes

time to learn what to eat and what not to eat. It might be a good idea for James and his family to

go to choose MyPlate.gov for ideas on meals within a certain amount of calories. It would show

them the essentials of nutritional value of foods. Change is a good thing and he can start slowly

on picking out the foods to consume for a healthier heart.

James does not seem to spend much time around many people and that could contribute to his

sedentary life style. There are several senior centers in all areas of Michigan when elders get

together and have monthly activity schedules are posted with activities. Getting out and meeting

new people might be something that would encourage James to change his life style a little and

there might be other like him to meet where he would get the encouragement needed to become a

little more physically active.

It is up to his James and his wife to begin creating a better meal plan, cutting down on fatty

foods, eating more fruits and vegetables, creating a meal plan for each week would be a good

start. Frozen vegetables are almost the same price as canned vegetables and are much healthier.

Instead of coffee and a donut in the morning a banana and a protein drink would be a better

choice.

Aging and having a chronic illness is not what people strive for in later years but it happens

being better educated in nutrition can help the aging process. James and his wife need to work

together as a team to get James motivated to get daily exercise and to have healthier meals.

Losing some weight would definitely benefit James in that he would have more energy and it

would be more beneficial to his heart. The only insurance James has is through the VA but if
perused they might have a nutritionist to help educate both James and his wife on a healthier

nutrition plan.

3 day menu under 1900 calories

Day One

Breakfast:

c bran flakes, 1c low fat milk, 1 slice of whole wheat toast, 1/4tspn margarine, 1c cranberry

juice

Lunch:

3/4c chicken salad with celery and low fat mayonnaise. 2 slices of whole wheat bread, c of

diced cucumbers and tomatoes with 2tspn of low fat Italian dressing

Dinner:

1 medium baked potato, 1c frozen green beans (steamed), 60z baked cod, 1c low fat milk
Day 2

Breakfast:

1c oatmeal, tsp. sugar, 1c milk, 1c cranberry juice, banana

Lunch:

Tuna with chopped celery and light mayonnaise, 2 slices of whole-wheat bread, slices of tomato

1 leaf lettuce, 1c pita chips (vegetable flavor)

Dinner: 6oz baked chicken, c brown rice, 1c broccoli steamed with low fat cheese sauce

Day 3

Breakfast:

1 whole wheat bagel with 1 tbsp. peanut butter, 1c milk, 4oz apple juice

Lunch:

3 slices of turkey breast, 2 slices of whole wheat bread, 2 slices of tomato, 1 leaf lettuce, 1tspn

spicy mustard, c of celery sticks, c carrots, 10z low-fat ranch dressing

Dinner:

Vegetable lasagna: lasagna noodles, zucchini, spinach, squash, low-fat cottage cheese, low fat

mozzarella cheese, tomato sauce, Mrs. Dash seasoning, whole wheat dinner roll, c steamed

carrots
Fresh fruit for desert in the evening with an option of having it with frozen yogurt of low fat

yogurt.

Seasoning with low sodium herbs preferably Mrs. Dash has a wide variety. Low sodium

margarine to be used with foods.