This document provides information on Coronary Artery Disease (CAD) and acute gastroenteritis. CAD is caused by plaque buildup in the coronary arteries which can lead to chest pain, shortness of breath, or heart attack. Symptoms of acute gastroenteritis include vomiting, diarrhea, abdominal pain and cramps, fever, and dizziness. The document then provides details on the case of a 58-year-old male patient presenting with vomiting, abdominal pain, chest pain, and general weakness. His medical history and examination results indicate diagnoses of CAD, hypertension, hypothyroidism, and acute gastroenteritis. He is started on treatment including aspirin, statins, beta blockers, antiemetics

1. CAD, ACUTE
GASTROENTERITIS
Presented By:
HASHIM SYED ALI ABBAS H.
MESCO COLLEGE OF PHARMACY.

2. INTRODUCTION TO DISEASE
 CAD:
Coronary artery disease (CAD) also known as atheroselerotic heart disease, coronary heart
disease. Coronary artery disease develops when your coronary arteries — the major blood vessels
that supply your heart with blood, oxygen and nutrients — become damaged or diseased.
Cholesterol-containing deposits (plaque) on
your arteries are usually to blame for coronary artery disease.
When plaques build up, they narrow your coronary arteries, causing your heart to receive less
blood. Eventually, the decreased blood flow may cause chest pain (angina), shortness of breath, or
other coronary artery disease signs and symptoms. A complete blockage can cause a heart attack.
Because coronary artery disease often develops over decades, it can go virtually unnoticed until
you have a heart attack. But there's plenty you can do to prevent and treat coronary artery disease
Start by committing to a healthy lifestyle.
 GASTROENTERITIS:
It is a medical condition characterized by inflammation of the gastrointestinal tract
that involves both the stomach and the small intestine resulting in vomiting or diarrhea or both an
abdominal pain . Dehydration may occur as a result. In most cases it is caused by rotavirus in
children and norovirus in adults. It is also caused by bacteria and parasites. Transmission occur du
to consumption of contaminated food or water. Signs and symptoms usually begin 12-72 hours
after contracting the infectious agent. If due to viral agent, the condition usually resolves within on
week. Some viral causes may also be associated with fever, fatigue, headache and muscle pain. If
the stool is bloody the cause is more likely to be bacterial. Some bacterial infections may be
associated with severe abdominal pain and may persist for several weeks.

3. SYMPTOMS
CAD:
 Chest pain (angina). You may feel pressure or tightness in your chest, as if someone were standing on
your chest. The pain, referred to as angina, is usually triggered by physical or emotional stress. It typically
goes away within minutes after stopping the stressful activity. In some people, especially women, this pain
may be fleeting or sharp and noticed in the abdomen, back or arm.
 Shortness of breath. If your heart can't pump enough blood to meet your body's needs, you may develop
shortness of breath or extreme fatigue with exertion.
 Heart attack. If a coronary artery becomes completely blocked, you may have a heart attack. The classic
signs and symptoms of a heart attack include crushing pressure in your chest and pain in your shoulder or
arm, sometimes with shortness of breath and sweating. Women are somewhat more likely than men are to
experience less typical signs and symptoms of a heart attack, including nausea and back or jaw pain.
Sometimes a heart attack occurs without any apparent signs or symptoms
GASTOENTRITIS:
 Vomiting
 Diarrhea
 Abdominal pain and cramps
 Fever
 Dizziness
 General weakness

5. SUBJECTIVE DATA
 Name Of The Patient: Md. Liyqath Ali.
 Age: 58.
 Occupation: RTC Conductor (Retired).
 IP NO:.
 Address With Ph NO:,.
 Date Of Admission:
 Date Of Discharge:.
COMPLAINTS
 Vomiting
 Giddiness.
 Insomia.
 Abdominal pain.
 Chest pain.
 Loss of appetide
 General weakness

6. PAST HISTORY
• Asthma since 10 years, medication taken were
bednisole-2mg and sorbitol-4mg.
• Hypertension since two months. Medicine taken was
telday-40mg
• Hypothyroidism since 4 years. Medicine taken was
thyrox-25mg
• Had Angioplasty ie stent to LAD on 09-01-2014 in
Lazaras Hospital and was discharged on 19-01-2014 and
was normal.
FAMILY HISTORY: Mother suffered from CAD

7. OBJECTIVE DATA
Routine
biochemical
investigation
Haematologic
al
Investigations
RBS: 123mg/dl LDL: 82mg/dl Glob: 2.8g/dl RBC: 3.9m/cmm M: 03%
B.UREA: 25mg/dl HDL: 38mg/dl Na: 139meq/l WBC:
12,300/cmm
PLT:
4,43,000/cmm
S.CR: 1.7mg/dl BILE: T 1mg/dl
D
0.18mg/dl
K: 4.8meq/l N: 66% Hb: 11.0g/dl
T.Chol: 154 mg/dl T Protein: 7.3g/dl Cl: 102meq/l L: 27% PCV: 32 %
TGs: 172mg/dl Alb: 4.5g/dl E: 04%

8. URINE ANALYSIS
PHYSICAL CHEMICAL MICROSCOPIC
Appreance: Clear Albumin: -ve RBCs: Nil
Colour: Pale Yellow Sugars: -ve Pus Cells: 2-4
Reaction: Acidic Ketone Bodies: -ve Epi. Cells: 1-2
Specific Gravity: 1.020 Bile salts: -ve Crystals: Nil
Ph: 5.5 Bile Pigments: -ve

9. ECG REPORT
Q Waves in leads II, III and aVF show OLD inferior wall myocadial
infarction. Positive T waves in inferior leads also support the diagnosis of OLD
inferior wall myocardial infraction.
CORONARY ANGIOGRAM REPORT
o LMCA: Normal.
o LAD: Type III vessel, proximal 80% diffuse plaquing.
o Diagonals: D 1-ostial mild disease.
o LCX: Non dominant, Normal.
o OMS: Normal.
o RCA: Proximal 99% Lesion, Mid 100% occlusion..
o PDA/PLVB: Normal.
o LV ANGIO: Not done.
o CATH diagnosis: CAD-two vessel disease.
o Advice: PTCA+Stent to LAD.

10. ECHO CARDIOGRAPH &COLOUR DOPPLER REPORT
• Mitral valve: Normal.
• Aortic valve: Normal.
• Pulmonary valve: Normal.
• Tricuspid valve: Normal.
• Left atrium: 2.6cm.
• Aorta: 2.9cm.
• Left ventricle: RWMA: Akinetic anterior wall, Anterior IVS & apex.
• IVS: 0.7cm.
• EDD: 5.3cm.
• FS: 1.5%.
• EF: 31%.
• LVPW: 0.8cm.
• ESD: 4.6cm.
• LV mass: 138 grams.
CONCLUSION:
Ischemic Cardiomypathy.
CAD: RMWA of LAD, territory.
Severe LV dysfunction.
No LA/LV clot.
No significant stenotic or regurgitant lesions.

11. VITAL DATA
 Pulse rate: 86/min.
 Blood pressure: 130/95 mmHg.
 Respiratory rate: 24/min.
 Temperature: 98.5 F

12. ASSESMENT
HYPERTENSION: BP- 130/95 mm.Hg.
CAD: ECG- Abnormal Q& T waves.
2D ECHO: Ischemic Cardiomyopathy.
CAD: RMWA of LAD territory.
Severe LV dysfunction.
Coronary angiogram: LAD: Type III vessel, proximal, 80% diffuse
plaquing.
Diagonals: D1-ostial mild disease.
RCA: Proximal 99% lesion, Mid 100% occlusion.
CATH diagnosis: CAD-two vessel disease.
GASTROENTRITIS: Vomitting, Abdominal pain,
Diziness, Hard Stool.

13. PLANNING
 Day 1:
Pulse rate: 86/min.
BP: 130/95mmHg.
Respiratory rate: 24/min.
Temperature: 98.5F
TREATMENT CHART
Formulation Drugs Generic Dose Route Frequency
TAB ECOSPRIN ASPIRIN+CLOPIDOGREL 150mg ORAL OD
Bedtime
TAB CLOPILET CLOPIDOGREL 75mg ORAL BD
TAB PRAX PRASUGREL 5mg ORAL OD
TAB LIPICURE ATORVASTATIN 40mg ORAL OD
Bedtime
TAB TELDAY TELMISARTAN 40mg ORAL OD
TAB ZOLSOMA ZOLPIDEM 5mg ORAL OD
INJ EMESET ONDANSETRON 40mg IV OD
Bedtime

14. Day2:
Pulse Rate: 84/min.
BP: 130/90 mmHg.
Respiratory rate: 20/min.
Temperature: 98.5 F.
Continue Same Treatment (CST)
Add a tablet tide, generic-TORSEMIDE-10mg, ORAL, BD.
Add a tablet vertin, generic- MECLIZINE-24mg, ORAL, TID.
Add a syrup PATKLOR, generic-POTASSIUM CHLORIDE-
10ml, ORAL, BD.

15. Day3:
Pulse rate: 82/min.
BP: 130/95 mmHg.
Respiratory rate: 20/min.
Temperature: 98.5 F.
CST

16. Day4:
Pulse rate: 80/m.
BP: 110/70 mmHg.
Respiratory rate: 20/min.
Temperature: 98.5 F.
CST

17. DAY 5:
Pulse rate:80/min
BP:110/70mmHg
Respiratory rate:20
Temperature:98.5F
CST

18. DISCHARGE SUMMARY
FORMULATION DRUGS GENERIC DOSE ROUTE FREQ
TAB CLOPILET A CLOPIDOGREL+
ASPIRIN
150mg ORAL OD
TAB PRAX PRASUGREL 5mg ORAL OD
TAB ROSUVAS ROSUVASTATIN 20mg ORAL HS
TAB PROLOMET METOPROLOL 25mg ORAL BD
TAB TIDE TORSEMIIDE 10mg ORAL SOS
TAB PAN D PANTAPRAZOLE ORAL BBF
SYP POTKLOR POTASSIUM
CHLORIDE
10ml ORAL BD
TAB VERTIN MECLIZINE 80mg ORAL SOS
TAB THYROX THYROXINE 25mg ORAL OD

19. STANDARD TREATMENT PROTOCOL
CAD
 MORPHINE-50mg
 OXYGEN-2-4lit/min
 ANTIANGINALS(Nitroglycerine-2.5-6.5mg)
 ANTIPLATELETS(Aspirin-150-325mg)
 THROMBOLYTICS(streptokinase 1,1500,000 IU/hour)
 ANTICOAGULANTS(low mol. Wt .heparin-5000-10000IU in4-6 hours)
 STATINS(Rosuvastatin-5-40mg)
 BETA BLOCKER(Metoprolol-25-100mg)
 If blockage in arteries is more than 50% & it is a double vessel blockage
either PTCA or CABG is done

20. GASTROENTRITIS:
 Most cases of gastroentritis does not require any treatment and the symptoms will improve
within few weeks.medication is required in severe cases.
 Oral rehydration salts are recommended for people who are vulnerable to the effects
of dehydration, such as elderly people.
 Unless your symptoms are severe, medication to treat gastroenteritis is not usually needed. The
medications that are used to treat the symptoms of gastroenteritis are outlined below.
 Antidiarrhoeal medications
 Antidiarrhoeal medications are used to treat the symptoms of diarrhoea. Loperamide is a widely
used antidiarrhoeal medication for treating gastroenteritis.
 Anti-emetic medications are used to help prevent or reduce vomiting.
 Common anti-emetics include stemetil (prochlorperazine) and metoclopramide (which can be
given by injection directly into your muscles as well as orally).
 Antibiotics are not usually recommended for treating gastroenteritis because:
 most gastroenteritis cases are caused by viruses.even if gastroenteritis is caused by bacteria,
research shows that antibiotics are often no more effective and they can cause unpleasant side
effects
 Hospital treatment
 Admission to hospital is usually recommended when:
 repeated episodes of vomiting mean that you are unable to keep down any fluids
 you have symptoms that suggest severe dehydration, such as not passing any urine
 Treatment in hospital will involve administering fluids and nutrients intravenously (directly into
a vein).

21. INDICATIONS
 ASPIRIN+CLOPIDOGREL-Antiplatelet as given as prophylaxis in the above case
for CAD
 PRASUGREL-Antiplatelet given for CAD
 ATORVASTATIN-Statin given for CAD
 TELMISARTAN-Beta blocker given for HTN & CAD
 TORSIMIDE-Diuretic given for HTN
 ZOLPIDEM-Sedative/Hypnotic given for insomia
 ONDENSATRON-Antiemetic given for gastroentritis
 LEVOTHYROXINE-Thyroid product given for hypothyroidism
 MECLIZINE-vertigo given for gastroentritis
 SYP POTASSIUM CHLORIDE given for hypokalemia as in the above case use of
diuretic may cause hypokalemia

22. PHARMACIST INTERVENTION
 THE PRESCRIPTION IS FOUND TO BE RATIONAL.

23. PATIENT COUNSELLING
LIFE STYLE MODIFICATIONS
 Stop smoking
 Regular exercise: Do brisk walking atleast 20 mins daily
 DIET: A Heart healthy diet based on fruits, vegetables, &
whole grain & low in saturated fat & sodium
 Manage stress: Practice healthy techniques for managing
stress such as muscle relaxation & deep breathing.
DRUGS:
 Take medicines on time.
 Do not stop any medicine without consulting your doctor

24. .
THANK YOU!