M. Shareef, a 65-year-old male with diabetes and coronary artery disease, presented with chest pain, breathlessness, fever and vomiting for 6 hours. He was admitted to the ICU where an ECG showed signs of a myocardial infarction. His treatment included aspirin, clopidogrel, streptokinase, morphine and metoclopramide. As a known diabetic and heart disease patient, he requires lifestyle modifications and optimized medical management to control his risk factors and prevent further cardiac complications.
This document discusses cardiac emergencies including angina pectoris, myocardial infarction, and congestive cardiac failure. It defines each condition, lists causes and risk factors, describes signs and symptoms, outlines diagnostic tests and treatment options, discusses complications, and provides nursing management guidelines. Angina is chest pain due to decreased blood flow to the heart while myocardial infarction and congestive cardiac failure involve the heart's inability to pump sufficiently due to disease or damage. Prompt recognition and treatment are important to save lives during these deadly emergencies.
This document summarizes a seminar on coronary artery disease presented by Ms. Umadevi. K. It defines coronary artery disease as a narrowing of the coronary arteries that limits blood supply to the heart muscle. Risk factors include high cholesterol, smoking, hypertension, diabetes, and family history. Signs and symptoms include chest pain. Diagnosis involves ECGs, cardiac enzymes tests, echocardiograms, stress tests, and angiography. Treatment includes medications, angioplasty, stents, and bypass surgery to restore blood flow.
Cardiac arrest refers to the sudden cessation of cardiac activity and can lead to death if not treated. It is usually caused by conditions that disrupt the heart's electrical system such as coronary artery disease or structural heart abnormalities. Risk factors include a family history of sudden cardiac death, previous heart issues, and lifestyle factors like smoking and obesity. Diagnosis involves evaluating the patient's history, ECG, echocardiogram, and blood work. Treatment includes CPR, defibrillation, cardiac catheterization, bypass surgery, and medication to control arrhythmias and heart disease. Nursing care focuses on monitoring the patient's condition, providing oxygen, and educating on preventing future cardiac events.
This document defines and describes various cardiac dysrhythmias. It begins by defining normal sinus rhythm and dysrhythmias as disorders of the heart rhythm caused by disturbances in automaticity, conduction, or reentry of impulses. It then discusses the etiology, risk factors, pathophysiology and clinical manifestations of dysrhythmias. The major types of dysrhythmias are described in detail including their origins, characteristics and treatment approaches. These include rhythms originating in the sinoatrial node, atria, atrioventricular junction and ventricles such as sinus bradycardia, atrial fibrillation, premature ventricular contractions and ventricular tachycardia. Diagnostic assessment and management strategies are also
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.
This document discusses cardiac emergencies including angina pectoris, myocardial infarction, and congestive cardiac failure. It defines each condition, lists causes and risk factors, describes signs and symptoms, outlines diagnostic tests and treatment options, discusses complications, and provides nursing management guidelines. Angina is chest pain due to decreased blood flow to the heart while myocardial infarction and congestive cardiac failure involve the heart's inability to pump sufficiently due to disease or damage. Prompt recognition and treatment are important to save lives during these deadly emergencies.
This document summarizes a seminar on coronary artery disease presented by Ms. Umadevi. K. It defines coronary artery disease as a narrowing of the coronary arteries that limits blood supply to the heart muscle. Risk factors include high cholesterol, smoking, hypertension, diabetes, and family history. Signs and symptoms include chest pain. Diagnosis involves ECGs, cardiac enzymes tests, echocardiograms, stress tests, and angiography. Treatment includes medications, angioplasty, stents, and bypass surgery to restore blood flow.
Cardiac arrest refers to the sudden cessation of cardiac activity and can lead to death if not treated. It is usually caused by conditions that disrupt the heart's electrical system such as coronary artery disease or structural heart abnormalities. Risk factors include a family history of sudden cardiac death, previous heart issues, and lifestyle factors like smoking and obesity. Diagnosis involves evaluating the patient's history, ECG, echocardiogram, and blood work. Treatment includes CPR, defibrillation, cardiac catheterization, bypass surgery, and medication to control arrhythmias and heart disease. Nursing care focuses on monitoring the patient's condition, providing oxygen, and educating on preventing future cardiac events.
This document defines and describes various cardiac dysrhythmias. It begins by defining normal sinus rhythm and dysrhythmias as disorders of the heart rhythm caused by disturbances in automaticity, conduction, or reentry of impulses. It then discusses the etiology, risk factors, pathophysiology and clinical manifestations of dysrhythmias. The major types of dysrhythmias are described in detail including their origins, characteristics and treatment approaches. These include rhythms originating in the sinoatrial node, atria, atrioventricular junction and ventricles such as sinus bradycardia, atrial fibrillation, premature ventricular contractions and ventricular tachycardia. Diagnostic assessment and management strategies are also
A stroke occurs when the blood supply to part of your brain is interrupted or reduced, depriving brain tissue of oxygen and nutrients. Within minutes, brain cells begin to die.
Unstable angina is a form of ischemic heart disease where a person experiences chest pain or discomfort that occurs at rest or with minimal exertion. It is caused by decreased blood supply to the heart muscle due to partial blockage of the coronary arteries. Diagnosis involves taking a medical history, electrocardiogram, cardiac enzyme tests, and stress testing. Treatment consists of blood thinners, nitroglycerin, blood pressure medications, and cholesterol-lowering drugs medically or early cardiac catheterization and angioplasty or bypass surgery if high risk.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Angina pectoris is a type of chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. It is caused by an imbalance between the heart's oxygen supply and demand. There are several types of angina including stable angina, unstable angina, and variant angina. Risk factors that can trigger angina include atherosclerosis, coronary artery spasm, increased cardiac output from exercise or stress, and damaged heart muscle. Diagnosis involves taking a medical history, physical exam, ECG, blood tests, imaging tests like angiography, and exercise testing. Treatment focuses on lifestyle changes, medications like nitroglycerin, beta blockers, and calcium channel blockers, and procedures like
This presentation provides an overview of heart failure, including:
1. It defines heart failure as when the heart is unable to pump sufficiently to meet the body's needs, which can result from systolic or diastolic dysfunction.
2. Some key statistics on the incidence and prevalence of heart failure worldwide and in India are presented.
3. Heart failure is classified in different ways such as whether it affects the left or right side of the heart, and whether it involves forward or backward failure.
4. The etiology, clinical presentation, diagnostic assessment, medical management including medications, and surgical options for treatment are discussed at a high level.
This document discusses various abnormalities seen on electrocardiograms (ECGs). It describes sinus bradycardia, tachycardia, sick sinus syndrome and various types of heart block including first, second and third degree blocks. It also discusses bundle branch blocks, ventricular arrhythmias including extrasystoles, tachycardias and fibrillation. Myocardial ischemia and infarction are described along with ECG changes seen. Various electrolyte abnormalities and their effects on ECG tracings are also summarized.
Myocardial infarction, also known as a heart attack, occurs when an area of heart muscle is damaged due to inadequate blood flow. It is usually caused by atherosclerosis leading to narrowing or blockage of the coronary arteries. The left anterior descending artery supplies the anterior and septal walls of the heart, while the circumflex artery supplies the posterior and lateral walls. Obstruction of these arteries results in different types of MIs in the respective regions. Risk factors include age over 40, family history, male sex, obesity, diabetes, smoking, and hypertension. Symptoms include chest pain and potential radiation to the arm or shoulder. Diagnostic tests include electrocardiograms, cardiac enzymes, angiography, and imaging scans.
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
This document discusses coronary artery disease (CAD). It begins by defining coronary circulation and explaining the importance of the coronary arteries in supplying blood to the heart muscle. It then discusses atherosclerosis, the primary cause of CAD, and defines CAD as the narrowing or blockage of the coronary arteries due to plaque buildup. The document covers the incidence, risk factors, pathophysiology, clinical manifestations, diagnostic tests, and medical management of CAD.
1) Atrial fibrillation is the most common cardiac arrhythmia characterized by disorganized atrial activity without effective contractions. It increases risk of stroke and prevalence rises with age.
2) Management involves restoring sinus rhythm through drugs, cardioversion, or ablation or controlling heart rate and preventing clots with anticoagulants. Rate control uses beta blockers, calcium channel blockers, or digoxin while restoring rhythm uses antiarrhythmics, cardioversion, or ablation.
3) Treatment depends on whether AF is paroxysmal, persistent or permanent and involves restoring rhythm if possible or controlling rate and preventing complications if not.
Arrhythmias are abnormalities in heart rate or rhythm that arise from problems with the heart's electrical system. They can be caused by issues with impulse formation or conduction. Arrhythmias are classified as tachyarrhythmias, which involve fast heart rates, or bradyarrhythmias, which involve slow heart rates. Common arrhythmias include atrial fibrillation, atrial flutter, and various types of heart block. Diagnosis involves electrocardiography and other cardiac tests. Treatment may involve medications, cardiac ablation, implanted devices, or surgery depending on the type of arrhythmia.
Cardiogenic shock occurs when the heart is damaged and unable to pump enough blood to vital organs. This causes blood pressure to drop and organs to fail. It is a serious medical emergency. The heart loses its ability to contract effectively due to lack of oxygen and nutrients. Clinical features include low blood pressure, confusion, and poor organ perfusion. Treatment aims to improve cardiac function and oxygen delivery through medications, surgeries like bypass and stenting, and devices like intra-aortic balloon pumps. Nursing care monitors the patient's condition and supports the medical management of this critical condition.
Mitral valve stenosis involves a blockage of blood flow through the mitral valve due to abnormalities of the valve leaflets. It is commonly caused by rheumatic fever or infective endocarditis. Risk factors include acute rheumatic fever or streptococcal infections. The narrowed valve orifice increases pressures in the left atrium and lungs. Symptoms include fatigue, palpitations, and dyspnea. Diagnosis involves echocardiogram, electrocardiogram, and chest x-ray. Treatment may include diuretics, anticoagulants, balloon valvuloplasty, or valve replacement surgery. Nursing care focuses on monitoring for fluid overload, promoting rest and oxygenation, and educ
This document discusses aortic stenosis, including its definition as a narrowing of the aortic valve that obstructs blood flow from the heart. It notes the main causes are congenital heart defects where the valve has two leaves instead of three, calcium buildup in older individuals, and rarely, rheumatic fever. Epidemiology statistics provided show it occurs in 3 per 1000 births for congenital cases and is rare for rheumatic causes. Pathophysiology is described as the stenosis causing pressure overload on the left ventricle, eventually leading to dilatation and heart failure if longstanding. Clinical signs include dyspnea, angina, fainting, murmurs, and low pulse pressure. A case study example is
This document discusses pericarditis, an inflammatory condition of the pericardium. It defines pericarditis and lists various causes including viral or bacterial infections, connective tissue disorders, and cancers. Symptoms include chest pain relieved by sitting forward and a pericardial friction rub. Diagnostic tests include ECG, chest x-ray, and blood tests. Complications can include arrhythmias or pericardial effusion leading to cardiac tamponade. Treatment involves managing the underlying cause with antibiotics, NSAIDs, or corticosteroids. Nursing care focuses on rest, monitoring for complications, administering medications, and health education.
This document provides an overview of cardiac failure/congestive heart failure. It begins with an introduction and objectives. It then reviews heart anatomy and physiology, including the structure of the heart, conducting system, heart sounds, and ECG. It defines cardiac failure and discusses epidemiology, causes, pathophysiology, clinical manifestations, classifications, diagnostic process, medical management, and complications. Nursing management is also addressed using the nursing process approach.
Cardiac arrest occurs when the heart suddenly stops beating effectively due to electrical abnormalities or mechanical problems, disrupting blood flow. Signs include loss of pulse and consciousness. Diagnosis involves ECG and lab tests. Treatment follows the "chain of survival" - early CPR, defibrillation if needed, advanced life support, and post-cardiac care. Nursing management focuses on restoring cardiac output and tissue perfusion through CPR, medications, fluid therapy, and monitoring for complications from the arrest and treatment.
This document provides an overview of myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle due to sustained lack of blood supply. Common causes of MI include coronary thrombosis, arteriosclerosis, infections, hypoxia, smoking, excessive fat or exercise. Symptoms include severe chest pain, sweating, nausea, shortness of breath, and abnormal heart rhythms. Treatment involves pain medications, vasodilators, anticoagulants, thrombolytic drugs, antiarrhythmics, lifestyle changes like a low-fat diet, and potentially coronary artery bypass grafting or angioplasty procedures. Nursing diagnoses for patients include pain, anxiety, impaired cardiac output, limited activity,
This document discusses ischemic heart disease and coronary artery disease. Coronary artery disease is caused by atherosclerosis which develops due to risk factors like smoking, high blood pressure, high cholesterol, and diabetes. Clinical presentations include stable angina, unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Treatment involves lifestyle modifications, medications like antiplatelets, anticoagulants, and statins, as well as procedures like percutaneous coronary intervention and coronary artery bypass grafting.
Heart failure is a common condition where the heart is unable to pump enough blood to meet the body's needs. It can result from structural or functional disorders of the heart. The document provides details on the definition, causes, risk factors, pathophysiology, symptoms, diagnostic evaluation, classification systems, and treatment of heart failure. It emphasizes the importance of controlling risk factors, using medications such as ACE inhibitors and diuretics to manage symptoms, and making lifestyle changes like following a low-sodium diet and exercising regularly.
Myocardial infarction, also known as a heart attack, results from prolonged lack of oxygen supply to heart muscle, causing cell death. It is usually caused by a blockage of a coronary artery from an atherosclerotic plaque rupture. Symptoms include chest pain and shortness of breath. Diagnosis involves evaluating symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow, reducing workload and complications through medications like antiplatelets, anticoagulants, beta blockers, and ACE inhibitors.
This document summarizes a presentation on anesthesia for noncardiac surgery in patients with ischemic heart disease. It discusses the overview and risk factors for ischemic heart disease. It also outlines recommendations for screening, evaluation, preoperative preparation and optimization of patients, including medication management, anesthesia induction techniques to minimize hemodynamic changes, and goals for intraoperative management. The objective is to reduce perioperative cardiovascular risks for these high-risk patients undergoing noncardiac surgery.
Chronic obstructive pulmonary disorders COPD is a [preventable and treatable disease with some significant extra pulmonary effects that may contribute to the severity in individual clients.
It is characterized by airflow limitation that is not completely reversible.
Angina pectoris is a type of chest pain or discomfort that occurs when the heart muscle does not receive enough oxygen-rich blood. It is caused by an imbalance between the heart's oxygen supply and demand. There are several types of angina including stable angina, unstable angina, and variant angina. Risk factors that can trigger angina include atherosclerosis, coronary artery spasm, increased cardiac output from exercise or stress, and damaged heart muscle. Diagnosis involves taking a medical history, physical exam, ECG, blood tests, imaging tests like angiography, and exercise testing. Treatment focuses on lifestyle changes, medications like nitroglycerin, beta blockers, and calcium channel blockers, and procedures like
This presentation provides an overview of heart failure, including:
1. It defines heart failure as when the heart is unable to pump sufficiently to meet the body's needs, which can result from systolic or diastolic dysfunction.
2. Some key statistics on the incidence and prevalence of heart failure worldwide and in India are presented.
3. Heart failure is classified in different ways such as whether it affects the left or right side of the heart, and whether it involves forward or backward failure.
4. The etiology, clinical presentation, diagnostic assessment, medical management including medications, and surgical options for treatment are discussed at a high level.
This document discusses various abnormalities seen on electrocardiograms (ECGs). It describes sinus bradycardia, tachycardia, sick sinus syndrome and various types of heart block including first, second and third degree blocks. It also discusses bundle branch blocks, ventricular arrhythmias including extrasystoles, tachycardias and fibrillation. Myocardial ischemia and infarction are described along with ECG changes seen. Various electrolyte abnormalities and their effects on ECG tracings are also summarized.
Myocardial infarction, also known as a heart attack, occurs when an area of heart muscle is damaged due to inadequate blood flow. It is usually caused by atherosclerosis leading to narrowing or blockage of the coronary arteries. The left anterior descending artery supplies the anterior and septal walls of the heart, while the circumflex artery supplies the posterior and lateral walls. Obstruction of these arteries results in different types of MIs in the respective regions. Risk factors include age over 40, family history, male sex, obesity, diabetes, smoking, and hypertension. Symptoms include chest pain and potential radiation to the arm or shoulder. Diagnostic tests include electrocardiograms, cardiac enzymes, angiography, and imaging scans.
1. Ischaemic heart disease is caused by an imbalance between myocardial oxygen supply and demand, usually due to atherosclerosis limiting blood flow in the coronary arteries.
2. The main types of ischaemic heart disease are stable angina, unstable angina, myocardial infarction (STEMI and NSTEMI), and sudden cardiac death. Clinical presentation and ECG/biomarker findings are used to distinguish these conditions.
3. Treatment involves lifestyle modifications and medications like nitrates, beta-blockers, and calcium channel blockers to reduce oxygen demand and increase supply. Revascularization procedures like PCI or CABG may also be used in certain patients.
This document discusses coronary artery disease (CAD). It begins by defining coronary circulation and explaining the importance of the coronary arteries in supplying blood to the heart muscle. It then discusses atherosclerosis, the primary cause of CAD, and defines CAD as the narrowing or blockage of the coronary arteries due to plaque buildup. The document covers the incidence, risk factors, pathophysiology, clinical manifestations, diagnostic tests, and medical management of CAD.
1) Atrial fibrillation is the most common cardiac arrhythmia characterized by disorganized atrial activity without effective contractions. It increases risk of stroke and prevalence rises with age.
2) Management involves restoring sinus rhythm through drugs, cardioversion, or ablation or controlling heart rate and preventing clots with anticoagulants. Rate control uses beta blockers, calcium channel blockers, or digoxin while restoring rhythm uses antiarrhythmics, cardioversion, or ablation.
3) Treatment depends on whether AF is paroxysmal, persistent or permanent and involves restoring rhythm if possible or controlling rate and preventing complications if not.
Arrhythmias are abnormalities in heart rate or rhythm that arise from problems with the heart's electrical system. They can be caused by issues with impulse formation or conduction. Arrhythmias are classified as tachyarrhythmias, which involve fast heart rates, or bradyarrhythmias, which involve slow heart rates. Common arrhythmias include atrial fibrillation, atrial flutter, and various types of heart block. Diagnosis involves electrocardiography and other cardiac tests. Treatment may involve medications, cardiac ablation, implanted devices, or surgery depending on the type of arrhythmia.
Cardiogenic shock occurs when the heart is damaged and unable to pump enough blood to vital organs. This causes blood pressure to drop and organs to fail. It is a serious medical emergency. The heart loses its ability to contract effectively due to lack of oxygen and nutrients. Clinical features include low blood pressure, confusion, and poor organ perfusion. Treatment aims to improve cardiac function and oxygen delivery through medications, surgeries like bypass and stenting, and devices like intra-aortic balloon pumps. Nursing care monitors the patient's condition and supports the medical management of this critical condition.
Mitral valve stenosis involves a blockage of blood flow through the mitral valve due to abnormalities of the valve leaflets. It is commonly caused by rheumatic fever or infective endocarditis. Risk factors include acute rheumatic fever or streptococcal infections. The narrowed valve orifice increases pressures in the left atrium and lungs. Symptoms include fatigue, palpitations, and dyspnea. Diagnosis involves echocardiogram, electrocardiogram, and chest x-ray. Treatment may include diuretics, anticoagulants, balloon valvuloplasty, or valve replacement surgery. Nursing care focuses on monitoring for fluid overload, promoting rest and oxygenation, and educ
This document discusses aortic stenosis, including its definition as a narrowing of the aortic valve that obstructs blood flow from the heart. It notes the main causes are congenital heart defects where the valve has two leaves instead of three, calcium buildup in older individuals, and rarely, rheumatic fever. Epidemiology statistics provided show it occurs in 3 per 1000 births for congenital cases and is rare for rheumatic causes. Pathophysiology is described as the stenosis causing pressure overload on the left ventricle, eventually leading to dilatation and heart failure if longstanding. Clinical signs include dyspnea, angina, fainting, murmurs, and low pulse pressure. A case study example is
This document discusses pericarditis, an inflammatory condition of the pericardium. It defines pericarditis and lists various causes including viral or bacterial infections, connective tissue disorders, and cancers. Symptoms include chest pain relieved by sitting forward and a pericardial friction rub. Diagnostic tests include ECG, chest x-ray, and blood tests. Complications can include arrhythmias or pericardial effusion leading to cardiac tamponade. Treatment involves managing the underlying cause with antibiotics, NSAIDs, or corticosteroids. Nursing care focuses on rest, monitoring for complications, administering medications, and health education.
This document provides an overview of cardiac failure/congestive heart failure. It begins with an introduction and objectives. It then reviews heart anatomy and physiology, including the structure of the heart, conducting system, heart sounds, and ECG. It defines cardiac failure and discusses epidemiology, causes, pathophysiology, clinical manifestations, classifications, diagnostic process, medical management, and complications. Nursing management is also addressed using the nursing process approach.
Cardiac arrest occurs when the heart suddenly stops beating effectively due to electrical abnormalities or mechanical problems, disrupting blood flow. Signs include loss of pulse and consciousness. Diagnosis involves ECG and lab tests. Treatment follows the "chain of survival" - early CPR, defibrillation if needed, advanced life support, and post-cardiac care. Nursing management focuses on restoring cardiac output and tissue perfusion through CPR, medications, fluid therapy, and monitoring for complications from the arrest and treatment.
This document provides an overview of myocardial infarction (MI), also known as a heart attack. It defines MI as the death of heart muscle due to sustained lack of blood supply. Common causes of MI include coronary thrombosis, arteriosclerosis, infections, hypoxia, smoking, excessive fat or exercise. Symptoms include severe chest pain, sweating, nausea, shortness of breath, and abnormal heart rhythms. Treatment involves pain medications, vasodilators, anticoagulants, thrombolytic drugs, antiarrhythmics, lifestyle changes like a low-fat diet, and potentially coronary artery bypass grafting or angioplasty procedures. Nursing diagnoses for patients include pain, anxiety, impaired cardiac output, limited activity,
This document discusses ischemic heart disease and coronary artery disease. Coronary artery disease is caused by atherosclerosis which develops due to risk factors like smoking, high blood pressure, high cholesterol, and diabetes. Clinical presentations include stable angina, unstable angina, non-ST elevation myocardial infarction, and ST elevation myocardial infarction. Treatment involves lifestyle modifications, medications like antiplatelets, anticoagulants, and statins, as well as procedures like percutaneous coronary intervention and coronary artery bypass grafting.
Heart failure is a common condition where the heart is unable to pump enough blood to meet the body's needs. It can result from structural or functional disorders of the heart. The document provides details on the definition, causes, risk factors, pathophysiology, symptoms, diagnostic evaluation, classification systems, and treatment of heart failure. It emphasizes the importance of controlling risk factors, using medications such as ACE inhibitors and diuretics to manage symptoms, and making lifestyle changes like following a low-sodium diet and exercising regularly.
Myocardial infarction, also known as a heart attack, results from prolonged lack of oxygen supply to heart muscle, causing cell death. It is usually caused by a blockage of a coronary artery from an atherosclerotic plaque rupture. Symptoms include chest pain and shortness of breath. Diagnosis involves evaluating symptoms, electrocardiogram changes, and cardiac enzyme levels. Treatment focuses on restoring blood flow, reducing workload and complications through medications like antiplatelets, anticoagulants, beta blockers, and ACE inhibitors.
This document summarizes a presentation on anesthesia for noncardiac surgery in patients with ischemic heart disease. It discusses the overview and risk factors for ischemic heart disease. It also outlines recommendations for screening, evaluation, preoperative preparation and optimization of patients, including medication management, anesthesia induction techniques to minimize hemodynamic changes, and goals for intraoperative management. The objective is to reduce perioperative cardiovascular risks for these high-risk patients undergoing noncardiac surgery.
Anaesthetic Management of a Patient with Ischaemic Heart DiseaseZareer Tafadar
This document discusses the anaesthetic management of patients with ischemic heart disease undergoing non-cardiac surgery. It begins by defining ischemic heart disease and outlining its various manifestations including stable angina, unstable angina, and myocardial infarction. It then discusses preoperative evaluation and risk stratification of these patients, including medical history, physical exam, ECG, stress testing, and coronary angiography. Intraoperative management focuses on minimizing myocardial ischemia through beta-blockers, tight blood pressure control, and avoidance of tachycardia or hypotension.
An acute myocardial infarction (MI), commonly known as a heart attack, occurs when blood flow to the heart is blocked, injuring the heart muscle. Risk factors include previous cardiovascular disease, older age, smoking, high cholesterol, diabetes, high blood pressure, obesity, and chronic kidney disease. Treatment involves restoring blood flow through procedures like angioplasty or thrombolysis, along with medications like aspirin, nitroglycerin, and statins. Recovery involves cardiac rehabilitation with exercise training and lifestyle changes to manage risk factors and prevent future heart attacks.
The document provides information on myocardial infarction (MI or heart attack) including definitions, causes, pathophysiology, clinical manifestations, diagnostic tests, treatment, nursing management, and patient education. It defines MI as myocardial cell death due to prolonged ischemia. The main cause is sudden blockage of the coronary artery by a blood clot, causing irreversible damage to heart muscle. Clinical manifestations may include chest pain, shortness of breath, nausea, and changes in vital signs. Diagnostic tests include electrocardiogram, cardiac enzymes, and echocardiogram. Treatment focuses on reperfusion, reducing oxygen demand on the heart, and preventing complications. Nursing management involves monitoring for complications, relieving symptoms, promoting perfusion and respiratory function
A 75-year-old diabetic male presented with chest pain and other symptoms of acute coronary syndrome. The most probable diagnosis is myocardial infarction. Relevant investigations include ECG, biochemical markers like CK-MB and troponin, and echocardiogram. Management involves medical therapy in emergency, possible fibrinolysis or PCI, and long term preventative treatment. Complications can include heart failure, cardiogenic shock, arrhythmias if not properly managed.
This document provides information about myocardial infarction (MI) or heart attack. It defines MI as death of heart muscle cells due to lack of oxygen, usually caused by a blockage in the coronary arteries. It lists risk factors for MI such as smoking, diabetes, hypertension, and family history. It describes the signs and symptoms of MI, diagnostic tests including ECG and cardiac enzymes, types of MI, and treatments including thrombolytics, angioplasty, medications, and lifestyle changes to prevent future heart attacks. The nursing management of MI focuses on reducing pain, improving perfusion, preventing complications, health education, and calling for help if symptoms worsen.
1) The document discusses the anaesthetic management of patients with ischemic heart disease undergoing non-cardiac surgery. It covers preoperative evaluation and risk stratification, intraoperative management focusing on preventing myocardial ischemia, and postoperative monitoring and care.
2) Key points addressed include identifying risk factors for ischemic heart disease, evaluating functional capacity and surgical risk, optimizing hemodynamics under anesthesia, using regional anesthesia when possible, and monitoring for signs of perioperative myocardial ischemia.
3) Perioperative myocardial ischemia is often silent, but can be detected by ECG changes, hemodynamic instability, or elevated cardiac enzymes. Careful management is needed to minimize the risk of perioperative cardiac events in these high-risk patients.
This document provides an overview of the management of acute myocardial infarction (AMI or heart attack). It discusses the epidemiology, causes, symptoms, diagnostic criteria, risk factors, treatments, and complications of AMI. The main points are: AMI occurs when blood flow to the heart is blocked, causing death of heart muscle cells. It is a medical emergency treated with oxygen, nitrates for pain relief, aspirin, and reperfusion therapies like fibrinolytics or angioplasty. Goals of treatment are to prolong life, minimize heart damage, and prevent complications like heart failure, arrhythmias, and heart block. Lifestyle changes and long term medications are also important for recovery and prevention of future heart attacks.
This document provides an overview of acute coronary syndrome (ACS). It defines ACS and describes the epidemiology in Malaysia. The pathophysiology, classification, clinical presentation and investigations are discussed for unstable angina/NSTEMI and STEMI. Management is outlined for both conditions, including medications, fibrinolytic therapy, percutaneous coronary intervention and complications. A clinical case of STEMI is then presented demonstrating diagnosis and management. The document concludes with references to Malaysian clinical practice guidelines for ACS.
Periodontal treatment for medically compromised patientsDr.IA.AYISHA TALAT
A detailed and very accurately explained the treatment of periodontal diseases in medically compromised patients.
And explains the connection between the various systems of the human body and oral health.
CORONARY ARTERY DISEASE in medicine and nurses.pptxfmwansagalizye
This document discusses coronary artery disease (CAD) and angina pectoris. It defines CAD and describes the different types of angina. Risk factors for angina include atherosclerosis, smoking, diabetes, hypertension, high cholesterol, obesity, and sedentary lifestyle. Signs and symptoms include chest pain and shortness of breath. Diagnosis involves ECG, echocardiogram, angiogram, and stress testing. Nursing management focuses on reducing anxiety, preventing pain by balancing activity and rest, and teaching self-care and management of modifiable risk factors.
This document provides an overview of coronary artery disease and acute coronary syndrome. It discusses the biology and risk factors of atherosclerosis, clinical features and management of stable angina, and pathophysiology and treatment of ST-elevation myocardial infarction. Key points covered include the definition and types of acute coronary syndrome, diagnostic testing for stable angina including stress testing and coronary angiography, and medical therapies for stable angina such as antiplatelet drugs, nitrates, beta blockers, and calcium channel blockers.
- The patient, a 37-year-old male painter, was admitted with complaints of breathlessness and cough for one week. He had a history of rheumatic heart disease for 8 years and had discontinued his medications for one week.
- Examination revealed an irregularly irregular pulse, raised JVP, murmurs, and signs of heart failure. Echocardiography showed rheumatic mitral stenosis and regurgitation, aortic regurgitation, and a left atrial thrombus.
- During hospitalization, the patient developed chest pain and was found to have an anterior wall myocardial infarction, likely due to embolism from the left atrial thrombus. The final diagnosis was rheum
This document provides information on dental management of patients with cardiac conditions. It begins by outlining intended learning objectives which are to recognize systemic diseases requiring special consideration before dental treatment, collect relevant medical data from patients, differentiate between cardiac and cardiovascular diseases, and determine appropriate dental management for patients with cardiovascular diseases. It then discusses classifying a patient's physical status using ASA classifications. The document provides details on management of specific cardiac conditions like ischemic heart disease, valvular diseases, congestive heart failure, and infections like infective endocarditis. It also discusses conditions like rheumatic fever, heart murmurs, hypertension, and the use of pacemakers. Guidelines are provided for preoperative investigations, classifications of diseases, dental treatment modifications
The document provides information on the management of heart failure in 2014. It discusses two cases of patients with heart failure. The first case involves a 69-year-old man (RS) with reduced ejection fraction and multiple hospital admissions who is treated with a biventricular pacemaker and optimization of medications, resulting in improved symptoms and ejection fraction. The second case discusses a 67-year-old man (ED) admitted with breathlessness who is found to have reduced ejection fraction and severe aortic stenosis, and is treated with diuretics, beta-blockers, and ACE inhibitors along with lifestyle counseling.
This document provides an overview of recent advances in the pharmacotherapy of congestive cardiac failure (CCF). It discusses the definition, epidemiology, classification, etiology and pathophysiology of heart failure. It then examines the signs and symptoms and management approaches, including both non-pharmacological and pharmacological measures. The pharmacological section focuses on the mechanisms of action of common drug classes used to treat CCF, such as diuretics, ACE inhibitors, beta-blockers, aldosterone antagonists, and inotropic drugs.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Promoting Wellbeing - Applied Social Psychology - Psychology SuperNotesPsychoTech Services
A proprietary approach developed by bringing together the best of learning theories from Psychology, design principles from the world of visualization, and pedagogical methods from over a decade of training experience, that enables you to: Learn better, faster!
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
• Evidence-based strategies to address health misinformation effectively
• Building trust with communities online and offline
• Equipping health professionals to address questions, concerns and health misinformation
• Assessing risk and mitigating harm from adverse health narratives in communities, health workforce and health system
5. CASE STATEMENT
M. Shareef is a 65 years old male patient having 76 kg weight from Abottabad. He is a
known case of diabetic patient since 12 years and Coronary artery disease for the last 2
years. He was admitted to hospital with the chief complaint of chest pain and
breathlessness for the last 6 hours. Patient had an episode of vomiting. He was
conscious and well oriented and overall health state was weak . Past medications
include Metformin 500mg TID. Patient was immediately admitted in ICU. Within 10
mins, ECG was performed and based upon diagnosis Oxygen & Cardiac rhythm
monitoring was performed. Further his management includes Aspirin 300mg PO,
Clopidogrel 600mg PO followed by 150mg daily for 1 week and 75mg daily thereafter,
Streptokinase 1 MIU/hr, Inj Morphine, Inj Metoclopromide I.V Stat 5mg/ml.
7. DEFINITION
MI is defined by the demonstration of
myocardial cell necrosis due to significant and
sustained ischemia. It is usually, but not
always, an acute manifestation of
atherosclerosis-related coronary heart disease.
MI results from either coronary heart disease,
which implies obstruction to blood flow due to
plaques in the coronary arteries or, much less
frequently, to other obstructing mechanisms
(e.g. spasm of plaque-free arteries).
any Necrosis(irreversible
death) in the setting of
myocardial
ischemia(prolonged lack of
oxygen supply) should be
labelled as MI
According to ACC/AHA:According to WHO:
8. EPIDEMEOLOGY
It has been reported that the majority of deaths (39%) in low- and middle-income
countries under the age of 70 years are due to CHD. Myocardial Infarction (MI) is
one of the major complications of CHD. The Asian population is more susceptible
to MI. It has been estimated that MI is 50% higher in South Asians than in white
people in the UK.
Another study showed that the high prevalence of MI risk factors in Pakistan with
more than 30% of the population over 45 years of age is affected by this disease.
However, there is a paucity of data on the estimates of CHD risk factor burden or
of its control status in Punjab, Pakistan. Moreover, only a little information on MI
risk factors has been reported in Peshawar and Rahim yar khan, Pakistan .
13. DIFFERENCE BETWEEN ISCHEMIA AND HYPOXIA
NOTE: Angina is due to hypoxia
MI is due to ischemia
Ischemia injures tissues faster than hypoxia
14. DIFFERENCE BETWEEN ANGINA AND MYOCARDIAL
INFARCTION
ANGINA MYOCARDIAL INFARCTION
Site: retrosternal, radiate to arm,
epigastrium, neck
As for angina
Precipitated by exercise or
emotion
Often no obvious precipitant
Relieved by rest, nitrates Not relieved by rest, nitrates
Mild/moderate severity Usually severe (may be silent)
Anxiety absent or mild Severe
No nausea or vomiting Nausea and vomiting are common
No increased sympathetic activity Increased sympathetic activity
16. Clinical problem Pathology
Stable angina Ischemia due to fixed artheromatosus
stenosis of one or more coronary arteries
Unstable angina Ischemia caused by dynamic obstruction
of a coronary artery due to plaque rupture
with superimposed thrombosis and spasm
Myocardial Infarction Myocardial necrosis caused by acute
occlusion of coronary artery due to plaque
rupture and thrombosis
Heart failure Myocardial dysfunction due to infarction
and ischemia
Arrhythmia Altered conduction due to ischemia and
infarction
Sudden death Ventricular arrhythmia , asystole of
massive myocardial infarction
18. DIAGNOSIS
These tests include:
Electrocardiography, Blood testing, and Echocardiography.
1. ECG changes:
ST segment elevation, followed by T wave inversion and Q waves, are associated
with transmural infarction.
ST segment depression and T wave inversion are associated with subendocardial
infarction
19. DIAGNOSIS
2. Blood Testing:
• Living myocardial cells contain enzymes and proteins (e.g., creatine kinase,
troponin I and T, myoglobin) associated with specialized cellular functions.
• These enzymes and proteins can be detected by a blood sample analysis.
• Serum cardiac markers:
o Creatinine phosphokinase (CK)
o Lactic dehydrogenase (LDH)
o Cardiac specific troponins (cTn)
20. DIAGNOSIS
3. Echocardiography:
• An echocardiogram may be performed to compare areas of the left ventricle that
are contracting normally with those that are not.
• The echocardiogram may be helpful in identifying which portion of the heart is
affected by an MI and which of the coronary arteries is most likely to be occluded.
30. Patients with MI and hypertension should be treated with goal to maintain Blood pressure.
Such antihypertensive drugs which reduce cardiovascular events in Myocardial infarction
patients are recommended (ACEI, ARB, β blockers and statins)
These drugs can be prescribed individually or in combination according to patient
condition.
31. Impaired cardiac function can worsen renal function, a complex interaction known as the
cardiorenal syndrome.
Such antihypertensive drugs which reduce cardiovascular events in Myocardial infarction
patients are recommended (ACEI, ARB, β blockers, diuretics, anti thrombotic and
vasodilators)
These drugs can be prescribed individually or in combination according to patient
condition.
32. It has been recognized for some time that diabetics experience a greater mortality during
the acute phase of myocardial infarction (MI) and a higher morbidity in the post
infarction period.
In patients with MI and diabetes, ACE inhibitors and β blockers should be prescribed
The prevention or retardation of nephropathy in the diabetic patient is a good example
in which ACE inhibitors act by diabetes-specific and nonspecific mechanisms.
33.
34.
35.
36. NON PHARMACOLOGICAL TREATMENT
Life style modification
Smoking cessation:
Two yrs after cessation risk of MI drops by 50%.
Vaccination:
Update vaccine due to more chances of infection
Angioplasty recommend:
In elderly patients
Physical activity and exercise:
Exercise 30 min per day regularly
Physical activity can help control blood cholesterol, diabetes, obesity as
well as help lower blood pressure.
Losing even 10% from current weight can lower your heart disease risk.
37. Diet Modification:
Diets rich in soluble fiber, vegetables, fruits, and
whole grains, and low in saturated fat and
cholesterol should be encouraged.
Low salt diet
Lipid Management:
Saturated fat (<7% of total calories).
Cholesterol and trans fatty acids (<200mg/day).
Plant sterols (2g/day).
Viscous fiber (10g/day)
Olive oil, rapeseed oil to be used instead of
saturated oil.
Use of omega-3 fatty acids (fish).
38. PATIENT COUNCELLING
• Eat low salt diet to maintain Blood pressure
• Take low fat diet to reduce cholesterol level
• Exercise 30mins 3-4 times
• If smoker quit smoking
• Don't take certain medicines without your doctor
advise (NSAIDS, vitamins supplements)
• Update vaccination due to chances of infection
• Losing weight
40. CASE STATEMENT
M. Shareef is a 65 years old male patient having 76 kg weight from Abottabad on 20th
April,2017. He is a known case of diabetic patient since 12 years and Coronary artery
disease for the last 2 years. He was admitted to hospital with the chief complaints of
fever, chest pain and breathlessness for the last 6 hours. Patient had an episode of
vomiting. He was conscious and well oriented and overall health state was weak .Past
medications include Metformin 500mg TID, enalapril 20mg OD, Carvedilol 25mg OD
and atorvastatin 20mg OD. Patient was immediately admitted in ICU. Within 10 mins,
ECG was performed and based upon diagnosis Oxygen & Cardiac rhythm monitoring
was performed. Further his management includes Aspirin 300mg PO, Clopidogrel
600mg PO followed by 150mg daily for 1 week and 75mg daily thereafter,
Streptokinase 1 MIU/hr, Inj Morphine, Inj Metoclopromide I.V Stat 5mg/ml.
41. Patient name: Muhammad Shareef
Age: 65 years
Gender: Male
Date of Administration: 20th
April, 2017
Admission department: Emergency
42. Chief complaint:
Chest pain for last 6 hours
Breathlessness for last 6 hours
Fever (101 F) for last 6 hours
Episodes of vomiting
Past medical history:
Diabetes mellitus since 12 years
Coronary artery disease for last 2 years
43. Past medication history:
Metformin 500mg TID
Enalapril 20mg OD
Carvedilol 25mg OD
Atorvastatin 20mg OD
Subjective finding
Chest pain
Breathlessness
Episodes of vomiting
Fever (101 F)
44. Objective finding
ECG: ST segment elevation & Q wave development
Cardiac biomarkers: Troponin T raised, CK-MB raised
Chest X-ray: Cardiothoracic ratio increased showing LV dilatation, pulmonary edema
not evident.
Blood tests: ESR & CRP raised
Recently diagnosed for
Patient is recently diagnosed for ST segment Elevation Myocardial
infarction (STEMI)
45. VITAL SIGNS
Sign Normal 1 2 3 Comments
BP
120mmHg/
80mmHg
160/90 150/90 140/90 Raised BP
TEMP 37 C 38.3 38 38 Pyrexia
RR 12-18/min 30 29 27 Tachypnea
PR
60-100
beats/min
115
beats/min
112
beats/min
112
beats/min
Tachycardia
46. Lab Interpretation
Normal range Lab value Interpretation
Hematology Data
ESR <20mm/hr 23mm/hr Raised
CRP <10mg/dL 19mg/dL
Raised (severity of
myocardial damage)
Normal range Lab value interpretation
Cardiac Biomarkers
Troponin T 0.01ng/ml 0.05 ng/ml
Diagnosis of cardiac
injury
CK-MB 3-5% 15%
Indication of myocardial
damage
51. MEDICATION
Brand name Generic name Formulation
Prescribed dose
(20/04/2017)
Morphine Morphine Inj 3.8mg/hr
Streptokinase Streptokinase Inj 1 MIU/hr
Metoclopramide Metoclopramide Inj 5mg/ml
Ascard Aspirin PO
300mg
Lowplat clopidogrel PO
600mg PO followed by 150mg
daily for 1 week & 75mg daily
thereafter
52. Class Brand name
Dosage regimen
prescribed
Route of
administration
Cost of
treatment
1st
line of drug for
respective disease
Antiplatelet
(Lowplat)
clopidogrel
600mg PO Rs.140/- Yes
53. Drug Caution ADRs Interactions Contraindications
Clopidogrel
Patient at risk
of increased
bleeding so
use with
caution in
surgery
patients
Bleeding
•Morphine(if orally
given) reduces the effect
of clopidogrel
•Clopidogrel with
aspirin chances of
bleeding
Hepatic & renal
Impairment,
hypersensitivity,
peptic ulcer
54. EVALUATION OF DRUG ADMINISTRATION
Prescribed time of administration Effect of Food Pharmacist Recommendation
In evening ----------
Should take regularly but if bleeding
occurs then inform doctor
Is the drug rational Is the drug cost effectiveness Any alternative drug
No, because its dose is not
according to guidelines but it is 1st
line of drug
Yes, according to patient socioeconomic
status
Cocard
Rs. /-95
55. Class Brand name
Dosage regimen
prescribed
Route of
administration
Cost of
treatment
1st
line of drug for
respective disease
Thrombolytic
agent
streptokinase
1 MIU/hr
Inj Rs.4738/- Yes
56. Drug Caution ADRs Interactions Contraindications
streptokinase
Bleeding
disorders, high
blood pressure,
endocarditis,
recent biopsy or
surgery, recent
injury,
any allergies.
Bleeding, nausea,
vomiting, fever,
Allergic reactions,
Respiratory
depression, Back
pain
The addition of aspirin
to Streptokinase(if orally
given) causes a minimal
increase in the risk of
minor bleeding but does
not appear to increase
the incidence of major
bleeding
Cardiac stroke,
trauma, bleeding
diathesis
57. EVALUATION OF DRUG ADMINISTRATION
Prescribed time of
administration
Effect of Food Pharmacist Recommendation
It administered as soon as
possible (within 6 hours after
symptoms (e.g. chest pain)
appear.
……………..
Should take regularly but if
bleeding occurs then inform
doctor
Is the drug rational Is the drug cost effectiveness Any alternative drug
No
No
Enoxaparin
(Rs:150)
58. Class Brand name
Dosage regimen
prescribed
Route of
administration
Cost of
treatment
1st
line of drug for
respective disease
Opioid
analgesic
Morphine
sulfate
1mg/1ml
2-4mg, every 5-10
mins
IV bolus Rs. /-354
Ist drug of choice for
pain associated with
myocardial infarction
59. Drug Caution ADRs Interactions Contraindications
Morphine
Cardiac
arrhythmia
Abdominal pain,
bronchospasm,
hypertension,
sedation
Morphine reduces the
effect of clopidogrel
Pheochromocytoma,
Heart failure
60. EVALUATION OF DRUG ADMINISTRATION
Prescribed time of administration Effect of Food Pharmacist Recommendation
Until pain relieve ---
Monitor patient heart rate &
respiratory rate
Is the drug rational Is the drug cost effectiveness Any alternative drug
yes
Yes, because no other cheaper alternative
is available
Morfscot 20mg /ml
Rs: /-400
61. Class Brand name
Dosage regimen
prescribed
Route of
administration
Cost of
treatment
1st
line of drug for
respective disease
Antiplatelet
Ascard
(Aspirin)
300mg loading dose PO Rs 52 Yes 1st
line
62. Drug Caution Contraindications ADRs
NSAIDS Allergic,
bronchospasm
Peptic ulcer, Bleeding
disorder, Cardiac failure
Increase bleeding time,
GI hemorrhage
63. EVALUATION OF DRUG ADMINISTRATION
Prescribed time of administration Effect of Food Pharmacist Recommendation
Every 30min ---- Monitor bleeding time
Is the drug rational Is the drug cost effectiveness Any alternative drug
Yes Yes
Loprin
(Rs 52)
65. Drug Caution ADRs Interactions Contraindications
Metoclopramide
Caution
while driving
,handling
machinery
or other
tasks
requiring
alertness
because it
may
produce
drowsiness.
Extrapyramidial
reaction,
drowsiness,
diarrhea, rash
-------
GI obstruction,
perforation or
hemorrhage,
pheochromocytoma
66. EVALUATION OF DRUG ADMINISTRATION
Prescribed time of administration Effect of Food Pharmacist Recommendation
Stat ---------- ----------
Is the drug rational Is the drug cost effectiveness Any alternative drug
No as drug is not cost effective, although it is
1st
line of drug, and its dose is according to
guidelines .
No, as its alternative is available.
Stomac
Rs. /-87.60
67. TREATMENT OUTCOME
Chest pain will be treated by Streptokinase and Inj Morphine
Fever will be reduced by using Anti-pyretics
Breathlessness will be controlled by Oxygen
Vomiting will be treated by Metoclopromide I.V Stat
68. PATIENT EDUCATION
Exercise 30 min per day 7 day a week
Diets rich in soluble fiber, vegetables, fruits, and whole grains, and low in
saturated fat and cholesterol should be encouraged.
Check your blood glucose levels routinely
Take your all medicines regularly.
Keep appointments for regular follow-ups