The document presents a case study of a 58-year-old male patient diagnosed with coronary artery disease (CAD) after experiencing symptoms such as shortness of breath, palpitations, and angina. Key findings from lab and diagnostic tests indicate risk factors like hypertension, diabetes, and obesity, and emphasize treatment options including pharmacological therapies and lifestyle modifications. The document also outlines drug interactions and patient counseling on managing CAD and prescribed medications.

1. CASE PRESENTATION ON
CORONARY ARTERY DISEASE
PRESENTED BY :
P.VIGNESWARI
II/VI PHARM.D
Y17PHD0821

2. BRIEF SUMMARY OF CASE
• A 58 years old male patient was admitted in the
hospital having chief complaints of shortness
of breath, palpitations and angina. And he is
having history of unstable angina and mild
MS.
• Above case was presented in the format of the
SOAP analysis

3. SUBJECTIVE EVIDENCE
• A 58 years old male patient
was admitted in the
hospital with chief
complaints of having
shortness of breath,
palpitations and angina
• And having history of
unstable angina.
• And his appetite and sleep
habits are normal

4. OBJECTIVE EVIDENCE
• PHYSICAL EXAMINATION
Temp : normal
P.R : 82/min
B.P : 120/80 mm of Hg
• OBJECTIVE EXAMINATION
CVS : S1 S2+
CNS : Normal
P/A : Soft

5. LABARATORY INVESTIGATIONS
S.NO PARAMETER OBSERVED VALUE NORMAL VALUE
1. HbA1c 6.8% 4.0 – 6.5
2. Total protein 8.6g/dl 6.0 - 8.2
3. Serum globulin 3.8g/dl 1.8 – 3.4
4. Neutrophils 85.0% 40.0 – 75.0
5. Lymphocytes 13.0% 20.0 – 45.0
6. Monocytes 1.0 % 2.0 – 10.0
7. WBC count 15400/cu.mm 4400 -11000
S.NO PARAMETER OBSERVED VALUE NORMAL VALUE
1. Prothrombin time test 20.5 sec 9.5- 14.0
2. APTT Test 35.6 sec 21.0- 32.0

6. DIAGNOSTIC TEST
• 2D ECHO REPORT :
IMPRESSION : RHD
Mild Mitral stenosis
Mild MR
Concentric LVH
Grade 1 diastolic dysfunction
Trivial AR/TR
No RWMA of LV
No clot/Veg/Effusion

7. ASSESMENT
Based on the subjective data and the objective data the final
diagnosis of the patient was found to be having CAD (
coronary artery disease)
• DEFINITION : It is caused by the atherosclerosis of the
coronary arteries that lead to restriction of the blood flow to
the heart
• ETIOLOGY : The major cause for CAD for this patient is
due to unstable angina
Other etiological factors include : Heart attack
Shortness of breath
Angina

8. • Risk factors for CAD :
 High BP
 Diabetes
 Obesity
 High stress
 Unhealthy diet
 Lack of physical activity

10. CLINICAL PRESENTATIONS :
• Shortness of breath
• Palpitations
• Angina
• MI
• Chest pain
• Chest tightness
• Sweating
• Irregular heart beat

11. STANDARAD TREATMENT
• PHARMACOLOGICAL THERPAY:
Anti anginal medications like :
 Nitrates
 Beta adrenergic blockers
 Calcium channel blockers
 ACE inhibitors
 Statins
 Diuretic
 Imipramine for analgesia
SURGERIES LIKE :
 CABG
 Coronary angioplasty
 Heart transplant
 Stent

12. GOALS
 To prevent signs and symptoms by
sympthamatic therapy
 To avoid the further complications
 To decrease the disease progression
 And to increase the patients quality of life

13. CURRENT DRUG CHART
S.NO BRAND
NAME
GENERIC
NAME
DOSE R.O.A FREQ CATEGO
RY
INDICATI
ON
1. Pantocid Pantoprazole 40mg P/0 OD Proton
pump
inhibitor
Prophyla
ctic
2. Lopressor Metoprolol 50mg P/O OD Beta
blocker
Treatme
nt for
angina
3. Nitro-bid Nitrostat 2.6mg P/O BD Vasodila
tor
Treatme
nt for
angina
4. Duolin Ipratropium
salbutamol
0.5mg
2.5mg
P/N TID Anticholi
nergic
Beta2
agonist
For SOB
5. Budecort Budesonide 128m
cg
P/N TID Corticost
eroid
For SOB

14. DRUG INTERACTIONS
• Moderate :
1.Metoprolol and Albuterol : Metoprolol can cause
narrowing of the airways, which may worsen breathing
problems
Management : Generally be avoided or the dosage should
start low, preferably in divided doses to avoid
2.Metoprolo and Budesonide : Corticosteroids may
antagonise the effect of anti-HTN medications by using
sodium and water retention
Management : Ptn should be monitored regularly for BP,
electrolytes levels and body weight

15. PATIENT COUNSELING
• About Disease : CAD, also called coronary heart disease.
 The arteries, get plaque on their inner walls, which can make them
more rigid and narrowed. This restricts blood flow to your heart
muscle, which can then become starved of oxygen.
 The plaque could rupture, leading to a heart attack or sudden cardiac
death.
 It is mainly caused due to
HTN
DM
Obesity
Smoking
High cholesterol

16. • About drugs :
 Pantoprazole : Should b swallowed whole,donot split,
crush/chew. Should be taken 30 min before meal
 Metoprolol : Administer with or immediately following
food
 Nitrostat : Swallow it as whole, taken with or without food.
 Duolin : Administer via jet nebulizer to an air compressor
with an adequate air flow, equipped with a mouthpiece.
 Budesonide : Do not use ultrasonic nebulizers.

17. LIFE SYLE MODIFICATIONS
 Stop smoking – smoking is toxic to your heart and the
blood vessels
 Eat healthy diet – avoid food containing
fat,cholesterol,salt and sugar
 Get exercise – do exercise 30 min / day or 5 times in a
week
 Reduce or avoid excess weight
 Discontinue alcohol consumption – alcohol may
increase the levels of TG in blood and can leads to
atherosclerosis
 Control BP