The document presents a case study of a 66-year-old female patient admitted to the cardiology department with complaints of chest pain, shortness of breath, fever, and weakness for 3-4 days. Examinations found moderate left ventricular systolic dysfunction and an abnormal ECG. The patient was diagnosed with congestive heart failure, fever, arrhythmias, acidity, angina, constipation, and high cholesterol and treated accordingly with medications and lifestyle counseling.

1. CONGESTIVE HEART
FAILURE:
CASE PRESENTATION CCU, CARDIOLOGY
Presented by:
MOHAMMMED MISBAH UL HAQ
(170717882008)
Presented to:
MIRZA MISBA ALI BAIG
(ASSOCIATE PROFESSOR)
DEPT. OF PHARMACY PRACTICE
(DSOP)

2. OUTLINES :
• WHAT IS CHF
• CAUSES
• COMPLICATIONS
• TREATMENT
• THE CASE
• SOAP FORMAT

3. WHAT IS
CONGESTIVE HEART FAILURE?
• Congestive heart failure (CHF) is a chronic progressive condition that
affects the pumping power of the heart muscles.
• While often referred to simply as "heart failure," CHF specifically refers
to the stage in which fluid builds up around the heart and causes it to
pump inefficiently.

4. WHAT ARE THE MOST COMMON
TYPES OF CHF?
Left-sided CHF is the most
common type of CHF. It occurs
when the left ventricle doesn't
properly pump blood out to
the body. As the condition
progresses, fluid can build up
in your lungs, which makes
breathing difficult.
Right-sided CHF occurs when
the right ventricle has difficulty
pumping blood to the lungs.
Blood backs up in the blood
vessels, which causes fluid
retention in the lower
extremities, abdomen, and
other vital organs.

5. WHAT ARE THE MOST COMMON
TYPES OF CHF?

6. WHAT ARE THE CAUSES OF CHF?
* Hypertension
* Coronary artery disease
* Valve conditions : Valves that don’t open and close correctly may force
ventricles to work harder to pump blood and this can be result of heart
infection or defect.
* Diabetes, thyroid disease and obesity.

7. COMPLICATIONS :
* Atrial fibrillation
* Ventricular fibrillation or tachycardia
* Kidney failure
* Anemia
* Cardiac cachexia
* Heart valve condition
* Stroke

8. TREATMENT
Heart failure is a serious illness that affect life.
The major types of heart failure treatment includes:
* Lifestyle changes
* Heart Medications
* Surgery for correctable problems
* Implanted devices
* Heart transplant

9. PATIENT DEMOGRAPHIC
PROFILE:
PATIENT’S NAME Mrs. XYZ
IP NO. R118-013711
AGE 66 Years
GENDER Female
HEIGHT 5.6 feet
WEIGHT 85 kg
DATE OF ADMISSION 11/08/2018
UNIT CARDIOLOGY
PATIENT’S DETAILS
CHIEF COMPLAINTS:
• CHEST PAIN
• SHORTNESS OF BREATH
• FEVER, WEAKNESS : 3-4 Days

10. HISTORY OF PRESENT ILLNESS:
* The patient was asymptomatic 3-4 days back when she developed
weakness, fever. The patient complain of Chest pain & Shortness of
breath.
* Past history : K/C/O Hypertension, Diabetes Mellitus; since 15 years.
* Family history : Unknown
* Allergy : No Kind of Allergy
* Addiction : Paan

11. VITAL SIGN ON ADMISSION :
*Patient Vital sign :
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 72 b/min 24/min 100/60 mmHg
Provisional Diagnosis :
Congestive Heart Failure

12. REVIEW OF SYSTEMS :
*Cardiovascular System : S1 S2 +
*Respiratory System : BAE +, Crebs sound
*Central Nervous System : No Abnormality detected
*Abdomen : Soft
*Others - Glucose Random Blood Sugar Test : 260 mg/dl

13. LABORATORY INVESTIGATIONS :
2D ECHO COLOUR DOPPLER REPORT :
Conclusion :
* Dilated LA
* RWMA +
* Hypokinesia of Total IVS, Anterior & Lateral Wall of LV
* Moderate LV Systolic Dysfunction
* No Diastolic Dysfunction
* Moderate MR, Mild TR / PAH, No AR
* No Clot / PE / Veg

14. SEROLOGY REPORT :
INVESTIGATION METHOD REPORT
HIV 1&2 ANTIBODIES ALLERE COMBO NON-REACTIVE
HBsAg SD-BIOLINE NEGATIVE
HCV TRIDOT NON-REACTIVE
SERUM ELECTROLYTES :
TEST NAME FINDINGS UNIT NORMAL RANGE
SODIUM (NA+) 130 mmol/l 135-145
POTASSIUM (K+) 7.2 mmol/l 3.5-5.0
CHLORIDE (Cl-) 109 mmol/l 95-105
HS Troponin-I (TNHS) 12056 mg/L Upto 19

15. RENAL FUNCTION TEST :
TEST NAME FINDINGS UNIT NORMAL RANGE
BLOOD UREA 65 mg/dl 10-45
SERUM CREATININE 2.1 mg/dl 0.6-1.5
SERUM URIC ACID 6.8 mg/dl 2.4-5.7
INVESTIGATION RESULT
URINE FOR KETONE BODIES NEGATIVE
URINE FOR KETONE BODIES :
RADIOGRAPHY:
CHEST AP BED SIDE X-RAY HAS BEEN DONE.
ECG:
ABNORMAL ECG

16. HAEMATOLOGY :
INVESTIGATION FINDINGS NORMAL VALUES
HBG 10.6 g/dl 11-17
RBC 3.88 mil/cumm 3.8-6.5
WBC 22,130 cells/cumm 4,000-10,000
PLATELETS 438000 lacs 1,50,000-5,00,000
NEUTROPHILS 81.6 % 50.0-80.0
EOSINOPHILS 0.0 % 0.0-5.0
LYMPHOCYTES 13.1 % 25-50
MONOCYTES 5.2 % 2.0-10.0
RBC :
Normocytic,
Normochromic
WBC :
Neutrophilic
Leukocytosis
PLATELETS :
Adequate

17. COMPLETE URINE EXAMINATION :
EXAM REQUIRED RESULT
QUANTITY 15 ml
COLOUR PALE YELLOW
TRANSPERENCE SLIGHTLY TURBID
REACTION ACIDIC
SPECIFIC GRAVITY 1.015
EXAM REQUIRED RESULT
ALBUMIN +++
SUGAR +++
BILE SALT -
BILE PIGMENTS -
EXAM REQUIRED RESULT
PUS CELLS 20-25 /HPF
RED BLOOD CELLS 3-4 /HPF
EPITHELIAL CELLS 6-8 /HPF
CASTS NIL
CRYSTALS NIL
OTHERS BACTERIA PRESENT
PHYSICAL EXAMINATION :
CHEMICAL EXAMINATION :
MIICROSCOPIC EXAMINATION :

18. MEDICATION CHART :
DOSAGE
FORM
DRUG GENERIC
NAME
DOSE FREQ. ROA CATEGORY / USE
INJ DOBUTAMINE DOBUTAMINE 5 mcq/kg/hr IV SYMPATHOMIMETIC AGONIST
INJ MONOCEF CEFTRIAXONE 1 gm BD IV ANTIBIOTIC
INJ PAN PANTOPRAZOLE 40 mg OD IV PROTON PUMP INHIBITOR
INJ LASIX FUROSEMIDE 20 mg OD IV DIURETIC
INJ SODIUM
BICARONATE
SODIUM
BICARONATE
50 ml BD IV ANTACID AND ALKALIZER
INJ HEPARIN HEPARIN 5000 units TID IV ANTICOAGULANT
INJ HAI HAI TID IV

19. DAY NOTES & MANAGEMENT :
FIRST DAY
• Patient has unstable angina, Chest pain associated with fever,
giddiness and weakness
• Patient is conscious, coherent, cooperative.
• Advise : Chest X-Ray
* Cardiovascular System : S1 S2 +
* Respiratory System : BAE+
* Central Nervous System : No Abnormality detected
* Abdomen : Soft
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 68 b/min 24/min 100/60 mmHg

20. DOSAG
E FORM
DRUG GENERIC NAME DOSE FREQ. ROA CATEGORY / USE
TAB CLOPITAB CLOPIDOGREL 75 mg BID ORAL ANTIPLATELET
TAB AZTOR ATORVASTATIN 40 mg H/S ORAL LIPID LOWERING (STATIN)
TAB THYRONORM THYROXINE 25 mcg OD ORAL SYNTHETIC HORMONE
TAB AMCARD-AT AMLODIPINE,
ATENOLOL
5/50 mg OD ORAL CALCIUM CHANNEL BLOCKER
TAB ECOSPRIN ASPIRIN 325 mg OD ORAL NSAID
PWD K BIND
SACHET
CALCIUM
POLYSTYRENE
SULPHONATE
15 gm TID ORAL ION EXCHANGE RESIN
NEB DUOLIN LEVOSALBUTAMOL
, IPRATROPIUM
50 mcg/20 mcg QID NASAL ANTICHOLINERGIC
NEB BUDECORT BUDESONIDE 100 mcg QID STEROID

21. SECOND DAY
• Patient has no fresh complaints.
• Advise : RFT & Serum Electrolytes
• Rx : CST
*Cardiovascular System : S1 S2 +
*Respiratory System : BAE+
*Central Nervous System : No Abnormality detected
*Abdomen : Soft
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 86 b/min 20/min 100/70 mmHg

22. RENAL FUNCTION TEST :
TEST NAME FINDINGS UNIT NORMAL RANGE
BLOOD UREA 75 mg/dl 10-45
SERUM CREATININE 2.1 mg/dl 0.6-1.5
SERUM URIC ACID 5.1 mg/dl 2.4-5.7
TEST NAME FINDINGS UNIT NORMAL RANGE
SODIUM (NA+) 137 mmol/l 135-145
POTASSIUM (K+) 5.2 mmol/l 3.5-5.0
CHLORIDE (Cl-) 105 mmol/l 95-105
SERUM ELECTROLYTES :

23. THIRD DAY
• Patient has stable, no angina.
• Patient condition has improved.
• Rx : CST stop Inj. Sodium Bicarbonate, Tab. Amcard-AT
* Cardiovascular System : S1 S2 +
* Respiratory System : BAE+
* Central Nervous System : No Abnormality detected
* Abdomen : Soft
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 72 b/min 22/min 120/80 mmHg

24. DOSAGE
FORM
DRUG GENERIC
NAME
DOSE FREQ. ROA CATEGORY / USE
TAB STARPRESS XL METOPROLOL
SUCCINATE
25 mg OD ORAL BETA BLOCKER
TAB LANOXIN DIGOXIN 0.25 mg OD ORAL CARDIAC GLYCOSIDE
LIQ LACTIHEP LACTITOL 10 ml H/S ORAL LAXATIVE

25. LABORATORY INVESTIGATIONS :
2D ECHO COLOUR DOPPLER REPORT :
Conclusion :
* Dilated LA
* RWMA +
* Hypokinesia of Total IVS, Anterior & Lateral Wall of LV
* Moderate LV Systolic Dysfunction
* No Diastolic Dysfunction
* Moderate MR, Mild TR / PAH, No AR
* No Clot / PE / Veg

26. RENAL FUNCTION TEST :
TEST NAME FINDINGS UNIT NORMAL RANGE
BLOOD UREA 73 mg/dl 10-45
SERUM CREATININE 2.1 mg/dl 0.6-1.5
SERUM URIC ACID 4.7 mg/dl 2.4-5.7
TEST NAME FINDINGS UNIT NORMAL RANGE
SODIUM (NA+) 134 mmol/l 135-145
POTASSIUM (K+) 5.0 mmol/l 3.5-5.0
CHLORIDE (Cl-) 106 mmol/l 95-105
SERUM ELECTROLYTES :

27. FOURTH DAY
• Patient has stable, no angina, clean chest.
• Advise : CAG
• Rx : CST
*Cardiovascular System : S1 S2 +
*Respiratory System : BAE+
*Central Nervous System : No Abnormality detected
* Abdomen : Soft
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 72 b/min 22/min 120/80 mmHg

28. FIFTH DAY
• Patient has stable, no angina.
• Advise : 2D Echo
• Rx : CST
*Cardiovascular System : S1 S2 +
*Respiratory System : BAE+
*Central Nervous System : No Abnormality detected
*Abdomen : Soft
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 80 b/min 14/min 120/80 mmHg

29. SIXTH DAY
• Patient has no fresh complaints.
• Rx : CST
*Cardiovascular System : S1 S2 +
*Respiratory System : BAE+
*Central Nervous System : No Abnormality detected
*Abdomen : Soft
Temperature Pulse Rate Respiratory Rate Blood Pressure
98.6 F 86 b/min 18/min 110/80 mmHg

30. SUBJECTIVE:
A 66 year old female patient was admitted in Cardiology Department with chief
complaints of Chest pain, Shortness of breath, Fever, Weakness since 3-4 days.
OBJECTIVE:
* 2D ECHO- Moderate LV Systolic Dysfunction
* ECG- Abnormal
SOAP FORMAT:

31. ASSESSMENT :
PROBLEM 1 :
FEVER :
TREATMENT : TAB. ECOSPRIN
PROBLEM 2:
ARRHYTHMIAS :
TREATMENT : TAB. DIGOXIN
PROBLEM 3:
ACIDITY :
TREATMENT : INJ. PAN
PROBLEM 4:
CHEST PAIN (ANGINA) :
TREATMENT : TAB. STARPRESS XL

32. PROBLEM 5 :
CONSTIPATION :
TREATMENT : SYP. LACTIHEP
PROBLEM 6 :
HIGH CHOLESTROL :
TREATMENT : TAB. AZTOR
PROBLEM 7 :
HEART FAILURE :
TREATMENT : INJ. DOBUTAMINE

33. PLANNING/COUNSELLING :
ACTIVITY:
* You can do normal everyday activities as your body allows.
* Take rest breaks if you feel tired. Do not over exert.
* Stop activity if you have pain, shortness of breath or feel dizzy.
DIET:
* Follow a low sodium (salt) diet.
* Your doctor may also recommend a fluid limit.
* Choose foods and drinks with low or no salt. Remove salt shaker from
the table.
WEIGHT MONITORING:
* Weigh yourself every day at the same time and write it down.
* Take your weight log to doctor visits.
* Call your doctor if you gain 1.5‐2.5 kgs over 2‐3 days.