CASE PRESENTATION ON ACUTE CORONARY SYNDROME ,ANTERIOR WALL MYOCARDIAL INFERCTION,HYPERTENSION,TYPE-2 DIABETES MELLITUS,MODERATE LV DYSFUNCTION PRESENTED BY:- Chandana C 2nd pharm-D SSCP PATIENT DEMOGRAPHIC DETAILS:- NAME:-Chow…….. AGE:-67years GENDER:-Male WEIGHT:-64Kg HEIGHT:-162cm BMI:-24.4Kg/m2 IP NO.:-19020189 DOA:-14-2-2019 DOD:-16-2-2019 NAME:-Chow…….. AGE:-67years GENDER:-Male WEIGHT:-64Kg HEIGHT:-162cm BMI:-24.4Kg/m2 IP NO.:-19020189 DOA:-14-2-2019 DOD:-16-2-2019 NAME:-Chow…….. AGE:-67years GENDER:-Male WEIGHT:-64Kg HEIGHT:-162cm BMI:-24.4Kg/m2 IP NO.:-19020189 DOA:-14-2-2019 DOD:-16-2-2019 PATIENT HISTORY:- Past medical history:-Type-2 Diabetes mellitus, Hypertension Past medication history:-He didn’t take medication for type 2 diabetes mellitus, on regular prescription for Hypertension Social history:-NS Family history:-NS Allergies:-NKA Diet:-Vegetarian PROVISIONAL DIAGNOSIS:- Acute coronary syndrome –anterior wall myocardial infarction, type 2 diabetes mellitus, hypertension, moderate LV dysfunction FINAL DIAGNOSIS:- Type 2 diabetes mellitus, Hypertension, ACS-AWMI, Moderate LV dysfunction TREATMENT GOALS:- Do PTCA for AWMI Reduce infarct size To reduce signs and symptoms To prevent further complication To reduce morbidity and mortality rate of diabetes mellitus, hypertension, AWMI TREATMENT OPTIONS RECOMMENDED BY CLINICAL PHARMACIST:- Beta blockers:-atenolol, metoprolol Antiplatelet therapy:- ticagrelor, tirofiban, aspirin Potassium channel activator:-nicorandil ACE inhibitors:-Ramipril, captopril Biguanides:-metformin Sulfonylurea:-glimepiride, gliclazide, glipizide HMG COA reductase inhibitors:- atorvastatin, rosuvastatin, simvastatin PROBLEMS IDENTIFIED:- There is no treatment given for diabetes mellitus Heart rate is increased Blood glucose level is elevated PHARMACIST INTERVENSION:- Prescribe medication for diabetes mellitus Advice patient to take medication regularly for diabetes mellitus Reduce heart rate PATIENT COUNSELLING:- ABOUT DISEASE AND MEDICATION :- Educate patient about signs and symptoms and complications of disease Educate about morbidity and mortality Advice to take medication as per prescription Educate about route of administration and time of administration ABOUT LIFESTYLE MODIFICATION Do physical exercise Be physically active Take rest Take medication as per chart ABOUT DIET:- Consume fresh fruits and vegetables Moderate carbohydrate intake Low fat diet and dairy products Reduce sugar and salt intake Advice DASH diet THANK YOU Chandana C, Sree Siddaganga College of Pharmacy 18-04-2019

1. CASE PRESENTATION ON ACUTE
CORONARY SYNDROME ,ANTERIOR
WALL MYOCARDIAL
INFERCTION,HYPERTENSION,TYPE-2
DIABETES MELLITUS,MODERATE LV
DYSFUNCTION
PRESENTED BY:-
CHANDANA C
2ND PHARM-D
SSCP
1

2. PATIENT DEMOGRAPHIC
DETAILS:-
NAME:-CHOW……..
AGE:-67YEARS
GENDER:-MALE
WEIGHT:-64KG
HEIGHT:-162CM
BMI:-24.4KG/M2
IP NO.:-19020189
DOA:-14-2-2019
DOD:-16-2-2019
2

3. CHIEF COMPLAINTS ON
ADMISSION:-
C/O CHEST PAIN , SWEATING SINCE 3 DAYS, VOMITING OF
3-4 EPISODES
3

4. PATIENT HISTORY:-
PAST MEDICAL HISTORY:-TYPE-2 DIABETES MELLITUS, HYPERTENSION
PAST MEDICATION HISTORY:-HE DIDN’T TAKE MEDICATION FOR TYPE
2 DIABETES MELLITUS, ON REGULAR PRESCRIPTION FOR
HYPERTENSION
SOCIAL HISTORY:-NS
FAMILY HISTORY:-NS
ALLERGIES:-NKA
DIET:-VEGETARIAN
4

5. PROVISIONAL
DIAGNOSIS:-
ACUTE CORONARY SYNDROME –ANTERIOR WALL
MYOCARDIAL INFARCTION, TYPE 2 DIABETES MELLITUS,
HYPERTENSION, MODERATE LV DYSFUNCTION
5

6. SUBJECTIVE EVIDENCE OBJECTIVE EVIDENCE
K/C/O Type 2 diabetes mellitus Abnormal ECG indicates acute MI
or STEMI
K/C/O Hypertension ECHO indicates IHD
Chandana C, Sree Siddaganga College of Pharmacy 18-04-2019
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7. FINAL DIAGNOSIS:-
TYPE 2 DIABETES MELLITUS, HYPERTENSION, ACS-
AWMI, MODERATE LV DYSFUNCTION
7

8. TREATMENT GOALS:-
 DO PTCA FOR AWMI
 REDUCE INFARCT SIZE
 TO REDUCE SIGNS AND SYMPTOMS
 TO PREVENT FURTHER COMPLICATION
 TO REDUCE MORBIDITY AND MORTALITY RATE OF DIABETES
MELLITUS, HYPERTENSION, AWMI
8

9. TREATMENT OPTIONS
RECOMMENDED BY CLINICAL
PHARMACIST:-
 BETA BLOCKERS:-ATENOLOL, METOPROLOL
 ANTIPLATELET THERAPY:- TICAGRELOR, TIROFIBAN, ASPIRIN
 POTASSIUM CHANNEL ACTIVATOR:-NICORANDIL
 ACE INHIBITORS:-RAMIPRIL, CAPTOPRIL
 BIGUANIDES:-METFORMIN
 SULFONYLUREA:-GLIMEPIRIDE, GLICLAZIDE, GLIPIZIDE
 HMG COA REDUCTASE INHIBITORS:- ATORVASTATIN,
ROSUVASTATIN, SIMVASTATIN
9

10. PROBLEMS IDENTIFIED:-
 THERE IS NO TREATMENT GIVEN FOR DIABETES MELLITUS
 HEART RATE IS INCREASED
 BLOOD GLUCOSE LEVEL IS ELEVATED
10

11. PHARMACIST INTERVENSION:-
 PRESCRIBE MEDICATION FOR DIABETES MELLITUS
 ADVICE PATIENT TO TAKE MEDICATION REGULARLY FOR
DIABETES MELLITUS
 REDUCE HEART RATE
11

12. PATIENT COUNSELLING:-
*ABOUT DISEASE AND MEDICATION :-
1. EDUCATE PATIENT ABOUT SIGNS AND SYMPTOMS AND
COMPLICATIONS OF DISEASE
2. EDUCATE ABOUT MORBIDITY AND MORTALITY
3. ADVICE TO TAKE MEDICATION AS PER PRESCRIPTION
4. EDUCATE ABOUT ROUTE OF ADMINISTRATION AND TIME OF
ADMINISTRATION
12

13. ABOUT LIFESTYLE MODIFICATION:-
 DO PHYSICAL EXERCISE
 BE PHYSICALLY ACTIVE
 TAKE REST
 TAKE MEDICATION AS PER CHART
ABOUT DIET:-
 CONSUME FRESH FRUITS AND VEGETABLES
 MODERATE CARBOHYDRATE INTAKE
 LOW FAT DIET AND DAIRY PRODUCTS
 REDUCE SUGAR AND SALT INTAKE
 ADVICE DASH DIET
13

14. THANK YOU
Chandana C, Sree Siddaganga College of Pharmacy 18-04-2019
14