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- 1. CASE PRESENTATION ON MYOCARDIAL INFARCTION PRESENTED BY: P.DIVYA POOJA Y17PHD0822 II/VI PHARMD NIRMALA COLLEGE OF PHARMACY
- 2. BRIEF SUMMARY OF CASE • A 45 years old male patient was admitted in hospital with chief complaints of retrosternal pain, breathlessness. • He had a past history of HTN with no familial histories. • He is a known smoker and alcoholic since past 10 years. • This case was evaluated in SOAP format
- 3. SUBJECTIVE • A 45 years old male patient was admitted in hospital with chief complaints of retrosternal pain, breathlessness. His pain is insidious in onset, while patient is sleeping, constricting and radiating type of pain to jaw and is associated with palpitations. • He had a past history of HTN and no familial histories. • He is a known smoker and alcoholic since past 10 years. • His bowel & bladder habits are normal with normal appetite and sleep patterns.
- 4. OBJECTIVE • Physical examination- Conscious Temperature-98 c BP-130/80 mm of hg PR-80 beats/min RR-24 cycles/min • Systemic- CVS-S1S2+ CNS- NFND RS- BAE+ P/A- Soft
- 5. BIOCHEMICAL- RADIOGRAPHICAL- ECG: Normal sinus rhythm Abnormal ECG 2D ECHO: CAD RWMA+LAD Moderate LV systolic dysfunctioning S.NO. PARAMETER OBSERVED VALUE NORMAL VALUE 1. Serum creatinine 0.80 mg/dl 0.90-1.30 2. Hemoglobin 13.8 g/dl 14.0-18.0
- 6. ASSESSMENT • Based on the subjective and objective data, the final diagnosis was found to be AWMI. • Definition: Anterior ST segment elevation occurs when anterior myocardial tissue usually supplied by the left anterior descending coronary artery suffers injury due to lack of blodd supply. • It is the most common symptom of ACS.
- 7. ETIOLOGY & RISK FACTORS: • Smoking and alcohol intake • HTN • Age • Stress • Obesity
- 9. CLINICAL PRESENTATIONS • Chest pain, heaviness, tightness • Pain is observed in neck, shoulder and left arm • Dysopnea • Nausea & Vomiting • Diaphoresis • Anxiety • Arrhythmia
- 10. STANDARD TREATMENT • Anti-platelet • Thrombolytics • Statins, ACE inhibitors
- 11. PLAN GOALS- • To reduce chest pain • To get symptomatic relief • To avoid further complications • To decrease the disease progression
- 12. DRUG CHART S.NO BRAND GENERIC DOSE ROA FRE CATEGORY INDICATION 1. T.DYTOR PLUS Spironolact one Torsemide 50+ 10 mg p/o OD Diuretic To treat HTN 2. T.CLOPILET Clopidogrel 75mg p/o BD Anti platelet To reduce clot 3. T.STORVAS Atorvastati n 40mg p/o BD Statin To reduce cholesterol levels 4. T.ECOSPRIN Aspirin 150 mg p/o BD Anti-platelet To reduce pain and clot 5. T.PANTOCID Pantoprazol e 40 mg p/o OD PPI Prophylactic
- 13. DRUG INTERACTIONS Moderate- 1. Aspirin x Clopidogrel – Unusual bleeding and severe abdominal pain Management – Change in therapy in case of bleeding 2. Statin x Clopidogrel- Statin reduces the effect of clopidogrel Management – Monitor for altered efficacy of clopidogrel 3. Statin x Pantoprazole- May increase BV diameter, leads to liver toxicity Management – Discontinue therapy if CPK increases 4. Clopidogrel x Pantoprazole- Reduces the effect of clopidogrel Management – Substituted by any H2 antagonist
- 14. PATIENT COUNSELLING About disease- • Also known as heart attack • Occurs when there is a diminished blood supply to heart which leads to myocardial tissue damage. Often caused due to the formation of plaque • In this case, caused due to the excessive intake of alcohol and presence of HTN.
- 15. About drugs: • T.Clopidogrel- Administer without food • T.Pantocid- Take 15-20 min before breakfast • T.Aspirin- Administer with food/ full glass of water to avoid GI symptoms
- 16. SPECIAL INSTRUCTIONS • Include a variety of fruits, vegetables, whole grains and low fat dairy products • Start an exercise plan • Quit smoking & limit alcohol • Follow regular medications and checkups • Avoid fatty meals • Maintain BP levels
- 17. THANK YOU