Heart diseases are major reason for mortality and morbidity. This is the case on how depression and stress can lead to Heart disease and worsen the QOL of patient. Little changes in food style and your attitude towards your health can save your heart.

1. CASE PRESENTATION ON ICHEMIC
HEART DISEASE WITH ACUTE
CORONARY SYNDROME AND
DEPRESSIVE LIKE ILLNESS
By,
UMME HABEEBA A PATHAN
4TH PHARM D
ROLL NO 29
BAPUJI PHARMACY COLLEGE
DAVANGERE

2. SUBJECTIVE
• NAME : ABC
• GENDER : MALE
• AGE : 44
• IP NO : 19002178
• DOA : 12/12/19
• DOD : 16/12/19

3. • Reason for admission: c/o chest pain, occasional
dizziness, general weakness, lassitude, poor appetite,
auditory hallucination and sleep disturbance.
• Patient Medical history : h/o Asthamatic bronchitis
since 1 year, depressed mood, type 2 DM since 6 years,
left kidney stone and had perianal abscess operation in
2015.
• Patient Medication history : Amaryl (glimepiride) 1mg
OD, Ventolin evohaler, Mucosolvan TID and Anti
depressants.
• Family history : patient father is diabetic and had right
paralysis attack.
• Social history : nil
• Allergies : nil

4. OBJECTIVE
• O/E
• Weight : 80 kg
• BP : 110/90 mm Hg
• HR : 79bpm
• CVS : S₁ S₂ +ve,
• CNS : anxious and disturbed
• P/A : distended abdomen and descending colon felt
spastic.
• ECG : inverted T in LⅢ
• Echocardiography: impaired diastolic filling with mild
regurgitation, mild hypokinesia of apical and
speutamoid inferior walls .

5. CRANIAL CT STUDY
• IMPRESSION: Normal cranial contrast C.T. Study
LABORATORY INVESTIGATION
PARAMETERS OBSERVED VALUE
Hb 14.4g/dl
FBS 170 mg/dl
HbA1c 9.7%
Cholesterol 466mg/dl
Tri G 193 mg/dl
LDL 73mg/dl
LDH 330U/L
CK 48U/L
CK-MB 9U/L
AST 16U/L

6. • Urine examination showed glycosuria, 2-4 puff
cells/hpf and 1-3 RBCs/hpf
• Endoscopic biopsy showed H Pylori
Antibodies.

7. CARDIAC CATHETERIZATION DEPARTMENT
INTERVENTION REPORT
PROCEDURE TIME : 46 minutes
Ⅰ. Procedure: Coronary Angiogram
• Access: right femoral artery
Ⅱ Coronary Arteriogram:
• Left Circumflex: big artery giving 4 small obtuse marginal showing
long lesion around 85% in mid part.
Ⅲ Intervention Data
• Lesion description: Long, around 85% lesion in mid LCx
• Balloon: Maverick balloon 2.5/20 mm with twice inflation up to 10
atm
• Stent: Cypher Stent 2.5/23 mm with 12 atm inflation pressure for 30
seconds
• Post Intervention Results: Successful PTCA stenting of LCx artery
with zero residual stenosis.

8. ASSESSMENT
• Based on subjective and objective evidence
the patient is diagnosed with
Ischemic Heard Disease/ Coronary Artery
disease
TYPE 2 Diabetes mellitus
Anxiety depressive illness
Hyperlipidemia
Obesity.

9. GOALS OF THERAPY
• To remove the ongoing stress of lesion in
coronary artery.
• To reduce blood cholesterol.
• To control diabetes.
• To reduce signs and symptoms of patients.
• To improve the depressive mood of patients.
• To improve quality of life of patient.

10. PLAN
• DAY 1
Sl.no Drug Generic name Dose Class Frequency
1 T Jusprin Aspirin 81mg Anti platelet 1-0-0
2 T Plavix Clopidogrel 75mg Anti platelet 1-0-0
3 T Nexium Esomeprazole
magnesium
40mg PPI 0-1-0
4 T Lipitor Atorvastatin
calcium
20mg Anti
hyperlipidemia
0-0-1
5 T Glucophage Metformin 500mg Hypoglycemic 1-1-1
6 T Tilcotil Tenoxicam 20mg NSAIDs 0-0-1
7 T Ismo Isosorbide
mononitrate
20mg Nitrates 1-0-1

11. DAY 2
• PERCUTANEOUS CATHETIRIZATION
INTERVENTION (PCI) was done and stent was
placed in the left artery (LCx) of the heart to
inflate the 85% blockade long lesion.
PARAMETERS Rx
O/E
BP : 120/90 mm Hg
PR: 76 bpm
CST

13. DAY 3
PARAMETERS Rx
O/E
BP: 120/90 mm Hg
PR: 72 bpm
CST
DAY 4
PARAMETERS Rx
O/E
BP: 110/80 mmHg
PR: 72 bpm
CST

14. DAY 5
O/E BP: 120/80 mm Hg
PARAMETERS OBSERVED VALUE
Hb 14.4g/dl
FBS 130mg/dl
Cholesterol 166mg/dl
Tri G 95mg/dl
LDL 73mg/dl
Advise to discharge and to avoid mental and physical stress for 2-3 months

15. DISCHARGE MEDICATION
SL NO DRUG GENERIC NAME DOSE FREQUENCY
1 T Solian Amisulpride 200mg ⅟₂- ⅟₂- 1
2 T Effexor RX Venlafaxine HCl 150mg 0-0-1
3 T Amryl Glimepiride 1mg 1-0-0
4 T Pan 40 Pantoprazole 40 mg 1-0-0

16. GOALS ACHIEVED
• Patients life became better.
• Patients blood sugar, blood cholesterol were
controlled.
• Patients ischemic heart condition was
resolved
• Patient was clinically improved.

17. PHARMACIST ACTIVITY
• DRUG INTERACTIONS
1. Clopidogrel<> Esomeprazole
Severity: Major
Type: Pharmacodynamic interaction
Effect : Co administration of Clopidogrel with PPI
may reduce the cardio protective effect of
Clopidogrel.
Management: Co administration should be avoided.

18. .
2. Aspirin<> Clopidogrel
Severity: Moderate
Type: Pharmacodynamic
Effect: aspirin enhances the Clopidogrel action
of inhibition of platelet aggregation
Management: Long term co administration to be
avoided and also monitored for the risk of
bleeding.
• INTERVENTIONS
No interventions were found.

19. THANK YOU