This file contains information regarding the medical condition unstable angina, as well as a case study of an unstable angina patient in a soap format. Please go over all of the slides to get a complete picture of the situation. If you have any queries or suggestions, you can drop down in the comments below. Thank you!

1. CASE STUDY ON
UNSTABLE ANGINA

2. CONTENTS:
 Definition
 Etiopathogenesis
 Signs and symptoms
 Risk factors
 Diagnosis
 Medical & surgical management
 Subjective
 Objective
 Assessment
 Plan
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3. DEFINITION.
 Unstable angina is a condition in which your heart doesn’t get enough blood flow and
oxygen. It may lead to a heart attack.
 Angina is a type of chest discomfort caused by poor blood flow through the blood vessels
(coronary vessels) of the heart muscle (myocardium).
ETIOPATHOGENESIS:
 This is the most severe form of angina.
 The principal cause of unstable angina is coronary artery disease caused by a build up of
plaque along the walls of arteries.
 The plaque makes the arteries to become narrow and rigid. This reduces the blood flow to
the heart muscle.
 Supply-demand mismatch.
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4. Plaque disruption:
▪ This is a type of angina with severe fixed multi vessel coronary artery with disrupted atherosclerotic plaques.
↓
Acute MI
Accumulation of lipid-laden macrophages.
↓
Formation of atherosclerotic plaques.
↓
Increasing plaque instability
↓
Disruption of plaque.
Vasoconstriction and thrombosis
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5. CLINICAL MANIFESTATIONS:
 Chest discomfort that feels like tightness, crushing, pressure like, squeezing or sharp.
 Chest pain that radiates to upper extremities (usually on the left side or back).
 Anxiety, sweating.
 shortness of breath, dizziness, unexplained fatigue.
RISK FACTORS :
▪ Age (> 45 years for men, > 55 for women)
▪ Smoking
▪ Diabetes mellitus & Hypertension.
▪ Dyslipidemia
▪ Family history of cardio vascular disease.
▪ Kidney disease.
Diagnosis:
▪ 12 lead electrocardiogram
▪ troponin I
▪ CBC, Lipid profile, serum biochemistry.
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6. MEDICAL MANAGEMENT:
▪ Blood thinners (antiplatelet drugs) are used to treat and prevent unstable angina.
▪ These medicines may be able to reduce the chance of a heart attack or the severity of a heart attack that occurs.
▪ During an unstable angina event:
▪ Patient is given Heparin ( or any other blood thinner) and nitro glycerin ( under the tongue or through an IV).
▪ Other treatments may include medicines to control blood pressure, anxiety, abnormal heart rhythms, and cholesterol (such as a statin drug).
CASE STUDY ON UNSTABLE ANGINA 6

7. SUBJECTIVE
▪ An 66 year old female patient was admitted to the hospital with chief complaints of chest pain.
▪ K/c/o HTN &DM
PAST HISTORY:
▪ Pulmonary Koch’s- 3years back
▪ Presented elsewhere with c/o retrosternal chest pain radiating to back associated with SOB-grade II, palpitations since days.
▪ H/o recurrent on & off chest pain since few months.
TREATMENT HISTORY:
▪ Tab. Telmisartan- OD
▪ Tab. Gliclazide mr- PO-BID
▪ Tab. Isordil 10- PO-OD
▪ Tab. metformin -500mg-PO-BID
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8. Investigations advised:
2D Echo, Haemodynamic monitoring, Troponin I, CBP, ECG.
Vitals:
▪ BP: 130/80mmHg
▪ PR: 88/min
▪ RR: 18/min
▪ Temp: 98.3 F
▪ GRBS: 245mg/dl
▪ Spo2: 98% on room air.
General examination:
Conscious, coherent, cooperative
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9. HAEMATOLOGY:
Hb 13.2 gms% (12-15)
RBC 4.3* 106 u/l 4.2-5.4
PCV 41% (36-46)
WBC 8900/ul ( 4500-11000)
neutrophils 72% (40-80)
Monocytes 33% (20-40)
Lymphocytes 4% (2-10)
Eosinophils 1% (1-6)
Basophils 0% (0-2)
Platelets 2,72,000/ml 1,50,000-4,50,000
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10. 2D ECHO DIADNOSIS:
▪ No RWMA of LV
▪ Mild concentric LVH
▪ Sclerotic Aortic valve.
▪ Normal LV systolic function
▪ Grade I LV Diastolic dysfunction.
Serum creatinine : 1.18 mg/dL (0.5-1.04)
Provisional diagnosis: unstable angina
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Na+ : 136 mEq/L (135-145)
K+ : 3.9 mEq/L (3.4 - 4.4)
Cl- : 98mEq/L ( 97-100)
BIOCHEMISTRY

11. ASSESSMENT:
 A 66 years old female was admitted with the chief complaints of chest pain and was presented elsewhere with retrosternal chest pain radiating to
the back, associated with SOB grade II and palpitations since days.
 After examination the ECG and 2D echo shows mild concentric left ventricular hypertrophy.
 Shows aortic valve sclerosis & grade I LV dysfunction.
 She has a past history of pulmonary Koch’s 3 years back.
 She also complaints of hypertension and diabetes mellitus and also has a history of recurrent on and off chest pain since few months but no on
going pain.
 All the haematological and biochemistry findings are found to be normal except serum creatinine.
 Random blood sugar (RBS) is found to be very high.
 Due to the above conditions and laboratory findings. The patient was diagnosed with Unstable angina.
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12. Generic name Brand name Dose ROA Frequency D1 D2
Atorvastatin Atorlip.Tab 40mg PO OD ✓ ✓
Clopidogrel Clopivas.Tab 75mg PO OD ✓ ✓
Aspirin Ecosprin.Tab 150mg PO OD ✓ ✓
Pantoprazole Fupan.Inj 40mg IV OD ✓ ✓
Heparin Hep.Inj 1000µ IV QID ✓ ✓
MEDICATION CHART
▪ Atorvastatin is prescribed to the patient which helps in reducing the bad cholesterol formed.
▪ Clopidogrel along with aspirin is given to treat the worsening chest pain and to reduce the clots and keep blood vessels open.
▪ Intravenous heparin is given to prevent new cardiac events after an episode of unstable coronary artery disease (CAD), and also to retard the
progression of intracoronary thrombus and thus prevent myocardial infarction and death.
▪ Pantoprazole is prescribed as a prophylactic drug.
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13. PLAN
COMMUNICATION WITH DOCTOR:
 Troponin I test was advised but it was not performed.
 As serum creatinine levels are slightly high, levels should be monitored regularly.
 As the patient highly diabetic, treatment regimen should be prescribed.
 Lipid profile test was not advised.
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14. COMMUNICATION WITH PATIENT:
Life style modifications:
 Stop smoking if you have habit of
 Eat a healthy diet with limited amounts of saturated fats, trans fat, salt and sugar.
 Increase physical activity like exercise and walking.
 Avoiding stress and finding ways to relax.
Foods to be taken:
▪ Eat plenty of fruits, vegetables
▪ Eat plenty of whole grains.
▪ Eat non-fat or low fat dairy products.
▪ Eat lean proteins such as skinless chicken, fish & beans.
▪ Eat almonds each day and other dry fruits
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15. Food to be avoided:
▪ Avoid foods that contain high levels of sodium.
▪ Avoid foods that contain saturated fats.
▪ Avoid processed, fried and baked foods.
▪ Avoid soft drinks and alcoholic beverages.
Discharge medication:
 Tab Ecosprin-AV-75mg -OD at 2pm
 Tab. Gewer 2 twice daily (BID) before meals.
 Tab. Galvusmet 50 -500 mg BID before meals.
 FBS at review regular monitoring of glucose with a glucometer at home.
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16. Thank you
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