Stenosis

1. Case presentation
BY
KOKILA.PALA
VI/VI PHARM-D
613175802022
svcp
1

2. Patient demographic details
• Age:69yrs
• Sex:male
• Weight:56kgs
SOCIAL HISTORY
• Non smoker
• Non alcoholic
• Diet:low salt-normal diet
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3. Complaints on admission
• Dyspnea
• Chest pain
3

4. On examination
• Patient is conscious and coherent
• PR:74/min
• Temp:98.4F
• BP:144/70
• RR:20/min
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5. PAST MEDICAL HISTORY:
• Cardiac failure
• Known case of hypertension since 15yrs
• No past medication history
• No previous allergies
• No surgical history
• No family history
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6. Day wise vitals
VITALS D1 D2 D3 D4 D5 D6 D7 D8 D9
BP(mmHg) 144/70 130/70 149/72 138/74 138/74 130/70 110/70 110/70 100/75
PR(BPM) 74 70 68 64 68 68 82 82 84
RR(CPM) 22 20 22 22 20 20 20 22 26
TEMP N N N N N N N N N
Fluid
Intake(ml)
750 1000 1550 1600 2000 1500 1500 1500 1500
Fluid
Output(ml)
1500 1200 1200 1750 1900 1800 1600 1600 1650
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7. Lab parameters
PARAMETERS NORMAL RANGE LAB VALUE
Hb% M:13-17g%
F:12-15g%
11.3
*TLC 4-10 thousand 14.8
Creatinine 0.5-1.5mg/dl 0.71
BUN 7-20mg/dl 14.9
Sodium 135-145mmole/l 138
Potassium 3.5-5.1mmole/l 4.9
Chlorine 96-108mmole/l 104
RBC 4.5-5.5 million 4.61
Platelets 1.5-4.5lakhs 2.32
WBC 4-10 thousand 9.8
ESR M:0-22mm/hr
F:0-29mm/hr
20
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8. Tot Bilirubin Up to 1mg/dl 0.58
SGOT <42IU/L 19
SGPT <40IU/L 12
Alk phospatase 32-130IU/l 67
Tot proteins 6.5-8.5gms/dl 7.4
Albumin 3.5-5.0gms/dl 4.5
Globulin 2-3.5gms/dl 2.9
Uric acid M:3.4-7.2mg/dl
F:2.4-6.1mg/dl
5.1
*PT 11-13.5seconds 10.9
INR 0.8-1.1 0.99
Calcium 8.4-10.5mmole/l 9.2
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9. Others
Echocardiograpghy was done in which
the report shows:
• An echo-dense aortic valve with no cusp
motion
• Decrease in maximal aortic cusp separation
• Presence of Lv hypertrophy
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10. Soap note
SUBJECTIVE EVIDENCE:
• Chest pain
• Dyspnea
• OBJECTIVE EVIDENCE:
• TLC was increased
• PT was decreased
• Echo was done in which the report shows:
• An echo-dense aortic valve with no cusp motion
• Decrease in maximal aortic cusp separation
• Presence of Lv hypertrophy
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11. Assessment
DIAGNOSIS:
From the subjective,objective
evidence and the past medical history the
patient was found to be having aortic stenosis.
Surgery done:
Aortic root+hemiarch+innominate
artery replacement
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12. Drug Chart
DRUG ROA DOSE FREQ TIME 1 2 3 4 5 6 7 8
Lanoxin
(digoxin)
IV 0.25mg OD 8AM N N Y Y Y N N N
Conversyl
(perindopril )
oral 4mg OD 8AM N N Y N N N N N
Aten (atenolol) oral 25mg OD 8PM N N Y Y Y N N N
Asomex
(amlodipine)
oral 5mg OD 8AM N N Y Y N N N N
Acitrom
(nicoumalone)
oral 2mg BD 10AM
10PM
N N Y Y Y N N N
Lasix
(furosemide)
oral 20mg BD 6AM
6PM
N N N Y Y Y Y Y
PAN
(pantoprazole)
oral 40mg OD 7AM N N N N Y Y Y Y
Morphine IV 2mg OD 5AM N N N N N Y N N
Ecosprin(aspirin) oral 75mg OD 2PM N N N N N Y Y N
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13. Pharmacological plan
• Ecospirin 75mg once daily at 2PM
• PAN 40mg once daily before breakfast
• Morphine 5mg thrice daily
• Lasix 20mg once daily at 4PM
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14. Non pharmacological planning
• Reduce sodium intake which should not exceed 1.5gm/day
• Low fat diet should be taken
• Do yoga and meditation to relieve from stress
• Reduce stress and anger
• Digoxin should be taken after morning meals
• Furosemide causes sun sensitivity.So the patient should be advised
to use sunscreen
• Aspirin should be taken with a full glass of water and should be
taken at the same time each day
• Instruct patients to avoid cranberry juice while taking nicoumalone
• Atenelol should be taken on an empty stomach
• Pantoprazole should be taken in the morning before breakfast
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15. Thank you
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