A case presentation discusses a 45-year-old male patient with myocardial infarction characterized by retrosternal pain and breathlessness, linked to risk factors such as high blood pressure and smoking. The patient underwent several diagnostic tests revealing an anteroseptal infarct and received a treatment plan including antiplatelet and antihypertensive medications. Recommendations for lifestyle modifications and patient counseling on the disease and medication adherence were also provided.

1. CASE PRESENTATION ON
MYOCARDIAL INFARCTION
PRESENTED BY :
P.VIGNESWARI
Y17PHD0821
II/VI PHARM.D
NIRMALA COLLEGE OF
PHARMACY

2. • A 45 years of male patient was admitted in the hospital with Chief
complaints of Restrosternal pain and breatheless ness 10 days back
• And his pain is insidious in onset ,while patient is sleeping constricting
pain and radiation of pain to the jaw associated with palpitations was
observed.
• And he has sweating episodes associated with breatheless ness
• And he has a personal history of alcohol and smoking.
BRIEF SUMMARY OF CASE

3. SUBJECTIVE DATA
A 45 years old male patient was admitted in the
hospital with Chief complaints of Restrosternal pain and breatheless
ness.And his pain was radiating to jaw associated with palpitations.
He has no past history and his bowel and bladder movements were
regular and normal.

4. OBJECTIVE DATA
• PHYSICAL EXAMINATION
BP : 130/80 mm of hg
Pulse : 80/min
• SYSTEMIC EXAMINATION
CVS : S1S2+
P/A : Soft
CNS : NAD
RS : NAD
• LABORATORY INVESTIGATIONS
S.NO PARAMETER OBSERVED VALUE NORMAL VALUE
1. Serum creatinine 0.80 mg/dl (0.90-1.30)
2. Haemoglobin 13.8g/dl (14.0-18.0)

5. OTHER INVESTIGATIONS
• ECG: Normal Sinus rhythm
Left anterior fascicular block
Anteroseptal infarct, age undetermined
Abnormal ECG
• 2D Echo : CAD
RWMA
Moderate LV systolic Dysfunction
Trivial MR/TR
• CORONARY ANGIOGRAM : CAD-DVD
PTCA + stenting

6. ASSESSMENT
Based on subjective and objective data the final diagnosis of the
patient was found to be having MYOCARDIAL INFARCTION
DEFINITION : Also known as anterior wall myocardial infarction or
anterior ST segment elevation occurs when antertior descending
coronary artery suffers injury due to lack of blood supply
ETIOLOGY : Not known in this patient i.e Idiopathic
RISK FACTORS : High BP
. Diabetes
. Obesity
High stress

7. PATHOPHYSIOLOGY

8. CLINICAL PRESENTATIONS
• Retrosternal chest pain
• Pain radiating to back ,left arm ,neck/jaw
• Breathlessness
• Diaphoresis
• Nausea and vomiting
• Pain – crushing.

9. PLAN
• A) Goals : To avoid further complications
To decrease signs and symptoms
To decrease the disease progression
• B) Standard treatment :
Medications
1. Anti platelets
2. Anti coagulants
3. Analgesics
4. Fibrinolytic
5. Nitrates

10. DRUG CHART
S.no Brand
name
Generic
name
Dose R.O.A Freq Category Use
1. Dytor plus Spironolac
tone +
Torsenami
de
50mg
+
10mg
P/o OD K+
sparing
diuretic +
loop
diuretic
To treat HTN
2. Clopilet Clopidogr
el
75mg P/o BD Anti
platelet
Prevents clot
3. Storvas Atorvastat
in
40mg P/O OD HMG-coA
reductase
inhibitor
To decrease
cholesterol
levels
4. Ecospirin Aspirin 150mg P/O OD Anti
platelet
To prevent clot
formation
5. Pantocid Pantopraz
ole
40mg P/O OD Proton
pump
inhibitor
Prophylactic
drug

11. Drug Name M.O.A ADRs M.O.P
Dytor plus Competes with ald for
recep site in DCT , ing
Nacl & H2O excretion
Confusion,atlaxia,
dizziness
BP ,serum
electrolytes,RFTs
Clopidogrel Irreversibly blocks the
Component of ADP recep
Epistaxis,hematoma,Mino
rhemmorhage
Signs of bleeding,hb and
hematocrit
Atorvastatin Inhibit HMG-COA,+ of
LDL catabolism
Diarrhea,athralgia,
Nasopharyngitis
Lipid panel, hepatic
transaminase,CPK
Ecospirin Irreversibly inhibit cox-
1,2
Hemostasis, bleeding,
skin rash, edema
Signs of bleeding,Hb and
hematocrit
Pantoprazole Suppress gastric acid
secretions
Facialedema,skinrash,vert
igo,vertigo, headche
Serum mg levels

12. DRUG INTERACTIONS
MODERATE
• Aspirin and clopidogrel : In combination may cause unusual bleeding, severe abdominal pain, weakness
Management : Discontinue if any signs are observed
• Atorvastatin and clopidogrel : Stating may reduce the effect of clopidogrel
Management : Monitoring for altered efficacy of clopidogrel may be advisable if atorvastatin is co-
administered with clopidogrel
• Torsemide and Pantoprazole : Pantocid may cause decrease in mg levels and risk increased with torsemide
lead to palpitations, seizures
Management : Monitor for serum mg levels
• Statin and Pantoprazole : May increase the blood levels and effect of statin can cause liver damage
Management : Therapy should be discontinued if creatinine kinase is markedly elevated or if myopathy is
suspected or diagnosed
• Clopidogrel and Pantoprazole : Combining those may reduce the effectiveness of clopidogrel
Management : An H2 receptor antagonist may be substituted if an interaction is suspected

13. PATIENT COUNSELING
• About disease : Also known as Heart attack . Occurred when there is
diminished blood supply to heart which leads to myocardial cell
damage and ischemia

14. About Drugs :
1. Clopidogrel : Administer without regards to meals
2. Atorvastatin : Administer with or without food, may take without
regard to time of day
3. Aspirin : Do not crush; administer with food or full glass of water to
minimize GI distress
4. Pantoprazole : Should be taken 30 min before meals

15. LIFE STYLE MODIFICATIONS
• Avoid smoke.
• Control your blood pressure and cholesterol levels.
• Get regular medical checkups.
• Exercise.
• Maintain a healthy weight.
• Eat a heart-healthy diet.
• Manage diabetes.
• Control stress.
• If you drink alcohol, do so in moderate.