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1. CASE PRESENTATION ON MI
Roll no:17Q0705

2. SUBJECTIVE EVIDENCE
Patient Details:
 Name – XYZ
 Age-65
 Sex - Male
 Weight – 56 Kg
 IP No.-186349
 D.O.A – 1/8/20

3. • Reason for admission:
C/o Chest pain radiating
towards left shoulder, left arm*3 hrs before
admission, sweating during attack.
• Past medical history:
K/C/O Hypertension * 1 year
on Rx non adherent
• Past medication history: --
• Social history :
Chronic smoker * 12 years
(10beedies/day)

4. OBJECTIVE EVIDENCE
1]LABORATORY INVESTIGATIONS
DATE 1/8 2/8 3/8 4/8 5/8 6/8
BP 160/10
0
150/90 140/90 140/86 130/86 130/80
PULSE
RATE
90 88 86 88 82 82

5. 2]BLOOD COUNT:
PATIENT VALUE
Haemoglobin 11.2g/dL
WBC 8200 cells/mm³
Neutrophils 67%
Leukocyte 28%
Monophils 2%
Eosinophils 3%
Basophils 0%
Platelets 3.30 lakh cells/mm³
ESR 20 mm/Hr

6. 3]CARDIAC ENZYMES:
CKMB 146 IU/L
AST 124 U/L
LDH 1149 U/L

7. LIPID PROFILE TEST
TC : 179 mg/dL
HDL : 56 mg/dL
TG : 114 mg/dL
LDL : 125mg/dL
VLDL : 15mg/dL

8. RENAL FUNCTION TEST
• Urea : 28 mg/dL
• Serum Creatinine : 1.2 mg/dL

9. ELECTROLYTES
• Sodium : 120 m moles/L
• Potassium : 3.7 m moles/L
• Chloride : 98 m moles/L

10. OTHER INVESTIGATIONS
• ECG : ST wave elevation and T wave inversion
in V1 – V4

11. ASSESSMENT
Subjective evidence : C/o chestpain radiating to
left arm, associated with sweating
Objective evidence : elevated CKMB, AST,LDH
ECG shows ST elevation and T wave inversion
From subjective and objective evidence the patient
is diagnosed with MYOCARDIAL INFARCTION

12. GOALS OF TREATMENT
• To releive signs and symptoms
• Tp reperfuse the infarcted area as early as
possible
• To prevent further reocclusion and
reinfarction
• To prevent further complications
• To provide better patient care

13. TREATMENT CHART
O GENERIC NAME ROUTE DOSE FREQ 1 2 3 4 5
O2 inhalation 3L/min Y Y Y Y Y
Inj.Morphine Iv 4mg stat Y Y Y Y Y
Inj. Promethazine IV 12.5 mg stat Y Y Y Y Y
Inj.Streptokinase IV 1.5 MIU stat Y Y Y Y Y
T.Clopidogrel + Aspirin PO 75/150 mg 0-1-0 Y Y Y Y Y
Inj.NTG IV
infusion
2.5mcg/min Y Y Y Y Y
T.Atorvaststin PO 10mg 1-0-0 Y Y Y Y Y
T.Ramipril PO 5mg 1-0-0 Y Y Y Y Y
Inj.Dalteparin SC 5000 U 1-0-1 N Y Y Y Y

14. GOALS ACHIEVED
• Signs and Symptoms were releived
• Attempt was made to prevent complications.

15. DRUG INTERACTIONS
• Dalteparin + Clopidogrel
Either increases effects of other by
pharmacodynamic synergism.
• Aspirin + Ramipril
Results in a Significant decrease in renal
function
• Dalteparin + Ramipril
Dalteparin increases toxicity of ramipril

16. PHARMACIST INTERVENTION
• Troponin I levels were not estimsted
• PT,INR were not measured
• Sub therepeutic dose – Inj.Dalteparin
• Unindicated use of Promethazine

17. PATIENT COUNSELLING
• Take medications properly and regularly
• Smoking cessation
• Eating food with a high content of saturated or trans fatty
acids should be minimised, replaced by unsaturated fats
such as olive oil,avacados and nuts
• A balanced diet which is high in vegetables and legumes
to be taken
• Salt restriction in diet
• Exercise regulary
• Manage stress appropriately