A 63-year-old male patient presented with chest pain, chest tightness, and shortness of breath. Based on his symptoms and ECG findings of ST segment depression and T-wave inversion, he was diagnosed with angina pectoris. He was treated with medications including isosorbide dinitrate, aspirin, clopidogrel, atorvastatin, pantoprazole, and theophylline. After three days of treatment, his condition was stable and he was discharged home with medications and lifestyle advice to control his cardiovascular risk factors.

1. Case presentation on ANGINA PECTORIS
SUBMITTED BY
METI.BHARATH KUMAR
16DK1T0014
6th year internship
1

2. A 63 year old male patient of bearing
Ipno:18645 was admitted in the department of
general medicine III on 24/12/21
and got discharged on 26/1221
2

3.  Chest pain
 Chest tightness
 Shortness of breath
3

4.  No history of similar complaints in past
 Not known Hypertensive,Diabetes Mellitus,TB
patient
SOCIAL HISTORY :
 Known alcoholic,
 Known smoker
Marital status : Married
4

5. DATE PULSE RATE BLOOD PRESSURE CVS CNS RS
24/12/19 70 bpm 100/60 mm of Hg S1S2 + NAD BLAE +
25/12/19 80 bpm 110/60 mm of Hg S1S2 + NAD BLAE +
26/12/19 70 bpm 100/60 mm of Hg S1S2 + NAD BLAE +
5

6.  ECG REPORT : ST segment depression
Inversion of T-Wave
6
s.no parameter Observed
value
Normal value
1. Haemoglobin 8.5gmdl 11-16.5gmdl
2. RBS 112mgdl 110-180mgdl
3. T.C 11,700cum 3500-10000cum

7. On observing chief complaints,laboratory reports and
ECG report,the disease was diagnosed as ANGINA
PECTORIS.
7

8. Angina pectoris is the symptom
complex caused by transient myocardial
ischemia which is characterised by central
chest pain,discomfort or breathlessness.It
may occur when there is an imbalance
between mycardial oxygen supply and
demand.
8

9. Etiology :
Transient myocardial ischemia is the most
common cause for origin of Angina Pectoris,
Coronary artery obstruction,
Atherosclerosis,
Coronary embolism.
9

10.  During attack,heart rate may increases,
 Blood pressure is elevated,
 Heart sounds are more distant,
 Changes in pulse rate and respiration rate,
 Pain beneath the sternum,it radiates to
half straight through back into throat,jaws
and teeth also.
10

11. Excessive cardiac work and myocardial Oxygen
demand
Insufficient amount of Oxygen supplies to the
myocardium
fAs the myocardium becomes ischemic,the
coronary sinus blood pH falls and loss of
cellular potassium levels
hDue to anaerobic conditions,Glycolysis pathway
starts
Excessive production of Lactic acid
Accumulation of hypoxic metabolites
Pain occurs at chest region Angina pectoris 11

12. S.no Brand name Generic name Route Dose Frequency Days of
Treatment
1 2 3
1. T.SORBITRATE Isosorbide
dinitrate
Oral 5 mg OD   
2. T.ECOSPIRIN Aspirin Oral 150
mg
OD   
3. T.CLOPITAB Clopidogrel Oral 75 mg OD   
4. T.ATROVA Atorvastatin Oral 40 mg OD   
5. T.Deriphylline Theophylline oral 100mg OD   
6. INJ.PANTOP Pantaprazole IV 40 mg OD   
12

13. SOAP NOTES
13

14.  Chest pain
 Chest tightness
 Shortness of breath
OBJECTIVE :
 Haemoglobin : 8.5 gm
 Total count:11,700cum
 ECG REPORT : ST segment depression
Inversion of T-Wave
14

15. Based on symptoms and ECG the case is assessed and
diagnised as ANGINA PECTORIS.
 Patient has the condition of chest pain, so
sorbitrates are given.
 Aspirin and clopidogrel acts as antiplatelet drugs.
 Anti hyperlipidemic drugs is prescibed without
performing lipid profile test.
 Theophylline is used for SOB
15

16. DRUG INERACTIONS
Moderate : aspirin +clopidogrel
This combination may cause unusual
bleeding, severe abdominal pain, weakness,
and the appearance of black, tarry stools. You
may need a dose adjustment if you take both
medications.
Moderate atorvastatin +clopidogrel
This combination may reduce the effects of
clopidogrel. Consult your doctor promptly if
you have any signs of blood clots such as chest
pain, shortness of breath, sudden loss of
vision, or pain, redness or swelling in an
extremity.
16

17. Moderate: clopidogrel +pantoprazole
 Combining these medications may reduce the
effectiveness of clopidogrel in preventing
heart attack or stroke. The interaction is most
likely to occur if you are using a higher
dosage of pantoprazole than recommended
or if you are using it too frequently.
17

18. Moderate :atorvastatin +pantoprazole
Combining these medications may increase
the blood levels and effects of atorvastatin.
This can increase the risk of side effects such
as liver damage and a rare but serious
condition called rhabdomyolysis that involves
the breakdown of skeletal muscle tissue. In
some cases, rhabdomyolysis can cause kidney
damage and even death. You may need a dose
adjustment.
18

19. PLAN :
 continue Iso sorbide dinitrate 5mg od orally
 Continue aspirin 150 mg od orally
 Continue clopidogrel 75 mg od orally
 continue Atorvastatin 40 mg od orally
 continue pantoprazole 40 mg od
intravenously.
 Continue theophylline 100mg od
19

20.  Reduce cariovascular risk including
smoking,maintaining healthy weight,physical
activity and smoking is avoided.
 Try to avoid fatty acid and high cholestrol
food as much as possible
 Meat should be taken moderately
 Increased intake of folic acid in food is also
effective for patients suffering with
cardiovascular diseases
 Advice the patient try to stop alcohol intake.
20

21.  Atorvastatin should be taken at night time
only. And inform the patient about
rhabdomyolysis.
 Advice the patient to take pantop early in the
morning before food
21

22. Patient was admitted in rims with c/o of
breathlessness,chest pain and doctor diagnosed as
ANGINA PECTORIS based on ECG.Patient was
found to be stable and discharged on
26/12/21 and while discharge prescription
list was :
T.SORBITRATE
T.ECOSPIRIN
T.CLOPITAB
T.ATROVA
T. PANTOP
T.THEOPHYLLINE
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