The document presents a case study of a 60-year-old female patient admitted with anemia and congestive heart failure. Over the course of her 14-day hospital stay, she was treated with medications to manage her symptoms, including lasix, iron supplements, B vitamins, and medications for heart failure. Her condition gradually improved and she was discharged on medications including lasix, iron, pantoprazole, and medications for congestive heart failure.

1. A CASE PRESENTATION ON ANEMIA WITH
CONGESTIVE HEART FAILURE
Presented by,,
MARTIN SHAJI
Pharm. D

2. Patient name: Mrs.X
Age/Gender: 60 / F
Admission No. (IP): 49988.
Department/Ward/Unit: FM-IV
D.O.A: 10/08/2019
D.O.D: 24/08/2019
Admitting Diagnosis: Pedal edema.

3. Chief Complaints:
Abdominal pain since 10days. Pedal edema since 1 year pitting type.
Weakness, Fatigue, Motions since 2 days 3-4 episodes per day.
Generalized body pains since 5 days.
Past medical History:
A Known anemic patient since1 year.
Past Medication History:
Undergone 2packets of blood transfusion on one
month back.

4. Personal Habits:
Height/Weight: 48kg
Alcoholic/Smoker: Nil
Diet (veg/non-veg): Mixed
Education: Nil
Sleep: decreased since 3months.
Appetite: decreased since 3months.
Bowel & Bladder Habit: Normal
Family History: Nothing Significant

5. Lab Investigations:
Vital signs: Hematology:
Pulse rate: 82bpm Haemoglobin:7.0
(↓) (12-14g/dl)
Blood pressure: 130/80 mmof Hg
Liver function tests:
A.L.P :119(↑)(12-115IU/L)
ECG:
Poor R- Wave progression, Sinus tachycardia.

6. CONFORMATORY DIAGNOSIS:
“ANEMIA WITH CONGESTIVE HEART FAILURE”

7. SOAP NOTES
SUBJECTIVE EVALUATION:
A 60 years female patient was admitted in the general medicine
department of female IV ward with the chief complaints of
Abdominal pain since 10days. Pedal edema since 1 year pitting
type. Weakness, Fatigue, Motions since 2 days 3-4 episodes per
day. Generalized body pains since 5 days she is known anemic
patient since1 year. Undergone 2packets of blood transfusion on
one month back. Her personal habits showing decreased sleep and
appetite since 3months.

8. OBJECTIVE EVALUATION:
On General Examination, the patient was conscious
and coherent and showing pallor, icterus, clubbing, lymphadenopathy,
cyanosis.
On Physical Examination, the patient vital signs were
found to be
Blood pressure: 130/80 mm Hg Hematology:
Pulse rate: 82bpm Haemoglobin:7.0 (↓) (12-
14g/dl)
Liver function tests: A.L.P :119(↑)(12-
115IU/L)
ECG: Poor R- Wave progression, Sinus tachycardia.

9. ASSESSMENT:
Based on subjective and objective
evaluation the patient was diagnosed
with “ANEMIA WITH CONGESTIVE HEART
FAILURE"
PLANNING:
In order to treat the the patient symptoms and
disease the following treatment was given by the physician.

10. On Day 1:
Prognosis: RX :
Patient is conscious and coherent, 1. Plan for blood
transfusion.
BP: 130/80 mm of Hg, 2. Tab. B. complex-
67mg/PO/OD
PR:82bpm, 3. Tab.Pantoprazole-
40mg/P/O/OD
CVS:S1,S2+, 4. Tab. IFA-
335mg/P/O/OD
RS: BLAE+ 5. Inj. Cyclopam-
10mg/I.M/BD

11. On Day 2: RX :
Patient was C/C, Same treatment was continued.
BP: 136/70 mm of Hg,
PR: 86bpm,
CVS: S1S2 +,
RS: BLAE+

12. On Day 3: RX:
Patient was C/C, Same treatment was continued along
with
BP: 130/70 mm of Hg 5. Inj. Lasix(furosemide)- 20mg/IV/OD
PR: 86bpm 6. Tab. Aldactone(spironolactone) –
25mg/P/O/BD
CVS: S1S2 + 7. Back rest.
RS: BLAE+

13. On Day 4: RX:
Patient was C/C, Same treatment was continued along with
BP: 130/70 mm of Hg 8.Tab. Ecospirin-160mg/P/O/OD
PR: 86bpm 9.Tab. Clopidogrel-75mg/P/O/OD
CVS: S1S2 + 10. Tab. Atorvastatin-20mg/P/O/OD
RS: BLAE+ 11.Nebulisation with salbutamol
5mg in 1ml in 2ml NS/4th hr/Nasal/TID
12. One Packed cell for blood transfusion
13.Syp. Ambroxol-10ml/P/O/TID
14.Tab.Cetrizine-5mgP/O/OD.

14. On Day 5: RX :
Patient was C/C, 1.Tab. Clopidogrel-75mg/P/O/OD
BP: 140/80 mm of Hg, 2.Tab. Atorvastatin-20mg/P/O/OD
PR: 80bpm, 3. Inj. Lasix- 20mg/IV/OD
CVS: S1S2 + 4.Nebulisation with salbutamol
RS: BLAE+ 5mg in 1ml in 2ml NS/4th hr/Nasal/TID
Syp. Ambroxol-10ml/P/O/TID
O2 Inhalation -2lit/hr/P/O/TID
Back rest.
Tab. IFA- 335mg/P/O/OD
Tab. Vitamin B12-1mg/P/O/OD
Tab.Montek-10mg/P/O/OD
Inj.Hydrocortisone-100mg/IV/TID
Tab .Pantoprazole-40mg/P/O/OD

15. On Day 6: RX :
Patient was C/C, Same treatment was continued.
BP: 150/90 mm of Hg, without1,2,6 and
PR: 86bpm, 3. Inj. Lasix converts into Tablet
CVS: S1S2 + form -40mg/P/O/BD.
RS: BLAE+ 4.Tab.Cetrizine-5mgP/O/OD
On Day 7&8 &9 RX :
Patient was C/C, Same treatment was continued.
BP:100/50mm of Hg,
PR:80bpm,
CVS: S1S2 +
RS: BLAE +

16. On Day 10: RX :
Patient was C/C,
BP-120/80mmof Hg, Tab. Pantoprazole-40mg/P/O/OD
PR:78bpm, Nebulization with salbutamol
CVS: S1S2 +
5mg in 1ml in 2ml NS/4th hr/Nasal/TID
RS: BLAE+ Inj. Lasix- 20mg/IV/OD
Syp. Ambroxol-10ml/P/O/TID
Tab.Cetrizine-5mgP/O/OD.
7.Tab. B. complex- 67mg/PO/OD
8.Tab. IFA- 335mg/P/O/OD
9. Tab. Calcium+ Vitamin-D3-750mg/P/O/OD

17. On Day 11,12,13 RX :
Patient was C/C, Same treatment was continued.
BP:130/80mm of Hg,
PR:76bpm,
CVS: S1S2 +
RS: BLAE+

18. RX :
DISCHARGE MEDICATION:
1. Tab. B. complex- 67mg/PO/OD
Patient was C/C, 2. Tab.Lasix-20mg/P/O/OD
Vitals are normal 3. Tab. IFA- 335mg/P/O/OD
4. Tab. Pantop-40mg/P/O/OD
5. Tab. Atorvastatin-40mg/P/O/OD
6. Tab. Clopidogrel-75mg/P/O/OD
Asked for review after 1 week.

19. DRUG CHART:
Sl. No. DRUG NAME INDICATION DOSE ROA FREQUENC
Y
DRUG ADMINISTRATION
START AND END DATE
1 Tab. B. complex Anemia 67mg P/O OD 10/08/2019……..
2 Tab.Iron folic acid Anemia 335 mg P/O OD 10/08/2019 ……..
3 Tab.Calcium+
Vitamin- D3
Anemia 750 mg P/O OD 19/08/2019 ……..
4 Tab.Pantop Acidity 40mg P/O OD 10/08/2019 ……..
5 Inj. Lasix pedal edema 20mg IV OD 12/08/2019-23/08/2019
6 Tab. Aldactone pedal edema 25mg P/O BD 12/08/2019-14/08/2019
7 Tab. Clopidogrel CHF 75mg P/O OD 13/08/2019..
8 Tab. Atorvastatin CHF 20mg P/O OD 13/08/19….
9 Tab. Ecospirin CHF 160mg P/O OD 13/08/2019
10 Tab. Vitamin B12 CHF 1mg P/O OD 14/08/2019-18/08/2019
11 Syp. Ambroxol cough 10ml P/O TID 13/08/19-18/08/2019
12 Tab.Cetrizine cold 5mg P/O OD 13/08/2019-23/08/2019

20. PHARMACEUTICAL INTERVENTION:
The given prescription was found to be “irrational”,
Because there are “medication errors"
MEDICATION ERROR:
1.As patient had chief complaints of motions but treatment was not given for
this.
2.As patient prescription having Inj. Lasix. But, nurse was not administered
resulting in increased edema.
3. Ecospirin adult dose is 75 mg , provided 160 mg ,should rectified.
4. Cetirizine 10 mg is the right dose , prescription shows 5 mg .

21. PATIENT COUNSELLING:
Regarding Disease:
Congestive heart failure, popularly known as a heart failure is a serious
pathophysiologic state in which there is an inability or inadequate or
inefficient contraction of heart which is unable to meet the body’s metabolic
demands due to decreased cardiac output.
Regarding medication:
Tab. B complex:
It is of 67mg orally preferably should take after food once a day. It
is a vitamin given to improve blood levels. allergic reactions, muscle cramps
are possible side effects.
.

22. Tab. Lasix:
it is of 40mg should take preferably at morning after meals to avoid gastric
irritation and sleep disturbance. it is given to treat pedal edema. It commonly causes
orthostatic hypotension, thrombophlebitis, gastric irritation, anemia, leucopenia,
hyperuricemia, hyperglycemia.
Tab. Iron folic acid:
It is of 333.5mg should take once daily preferably at night times after meals along with
plenty of water. It is haematinic given to improve blood levels. it commonly causes
constipation, dark stools, stomach cramps etc.
Tab. Clopidogrel:
It is of 75mg should take without regard food
preferably afternoon. It given to reduce platelet aggregation. It commonly cause Edema,
Headache, Abdominal pain, Pruritus, Dyspepsia.

23. Tab. Atorvastatin:
It is of 40mg should take after food before
sleep. It is given to reduce cholesterol levels to reduce hypertension. It may cause
Constipation, Insomnia, Abdominal pain, Paresthesia, Sinusitis, Alopecia. Atorvastatin with
standard CHF therapy improved cardiac function and remodeling. Cardio-protective “pleiotropic”
actions of atorvastatin are anti-inflammatory, anti-fibrotic and anti-oxidative.
Thus, atorvastatin has a potential therapeutic value in the management of CHF patients.
Tab.Pantop:
It is of 40mg orally preferably should take
30min before breakfast once a day which decreases acid secretion in stomach,
nausea, vomiting, dizziness, headache, abdominal distension are common side effects.

24. Regarding Life – Style Modifications:
 Stop smoking. Smoking damages your blood vessels, raises blood pressure, reduces the
amount of oxygen in your blood and makes your heart beat faster.
 If you are overweight, adopt a sensible eating plan that will maintain your weight at the
desired level. One indicator of healthy weight is body mass index. BMI of 25 and above
is associated with high blood cholesterol, high blood pressure, and increased risk of
heart disease.

 Eat a healthy diet.
 Aim to eat a diet that includes fruits and vegetables, whole grains, fat-free or low-fat
dairy products, and lean proteins.
Salt Restriction.
 Some patients may need to reduce the amount of water 1-2lit/day they consume.

25. DISCUSSION:
According to the world health organization HF is defined as “a complex
clinical syndrome that can result from any structural or functional cardiac
disorder that impairs the ability of the ventricle to fill or eject blood.” whic
ultimately leads to deceased perfusion to all parts of the body and impairs their
functional capacity.
Symptoms:
 Dyspnea (breathlessness)
 Orthopnea
 Paroxysmal nocturnal dyspnea
 Reduced exercise tolerance, lethargy, fatigue
 Nocturnal cough
 Bilateral swelling of both lower limbs
 Ankle swelling
 Cyanosis

26. TREATMENT OPTIONS:
■ Pharmacological–
■ Digitalis Derivatives,
■ Diuretics,
■ Dilators,
■ Dopamine,
■ Diesterase Enzyme Inhibitors Etc.
■ Surgical procedures–
■ Coronary Artery Bypass Grafting Surgery (CABG), Valve Surgery,
Implantable Left Ventricular Assist Device (LVAD), Heart
Transplantation