A 45-year-old male presented to the ICU with chest pain, sweating, backache and vomiting. Examination found normal vitals except elevated heart rate. Tests showed elevated cardiac enzymes and ECG changes consistent with ST-elevated myocardial infarction (STEMI). He was treated with fibrinolytics, anticoagulants, antiplatelets and beta blockers. Over subsequent days his symptoms improved and he was discharged on aspirin, clopidogrel, atorvastatin and metoprolol with counseling on cardiac risk factors and medications.

1. Case presentation
on
Myocardial infraction
presenting by :
n.Satyavardhan rao
Pharm.d 2nd year

2.  Patient Name : mr.xxx
 Age : 45 Years
 Gender : male
 Ward : ICU
 DOA : 28/11/2015
 DOD : 2/11/2015
demographic details:

3. Chief complaints on
admission
 left sided chest pain since 8:00am
 sweating and backache
 one episode of vomiting
3

4. physical examination
Vital signs:
Temperature : Afebrile
Pulse rate : 80bpm
Respiratory Rate : 18breaths/min
Blood Pressure : 120/70 mmHg
ADV:
 CBC with ESR
 Chest x-ray,
 ECG s
 LFT , RFT , RBS , Serum electrolytes
4

5. PAST HISTORY:
PAST MEDICATION:NIL
PAST MEDICAL HISTORY:NIL
FAMILY HISTORY: NS
SOCIAL HISTORY: NS
ALLERGIES: NKA

6. LABORATORY INVESTIGATIONS:
TEST TEST VALUE REFERENCE
VALUE
Hb 16.7gm/dl 13-18gm/dl
TLC 10000 cells/cumm 4000-11000
cells/cumm
Neutrophils 59% 30 to 75%
Lymphocytes 15% 05 to 15%
Monocytes 02% 0 to 10%
Eosinophil’s 06% 01 to 06%
ESR 30mm/hour 1-20mm/hour
6

7. provisional diagnosis:
myocardial infraction
7

8. SOAP
Subjective evidence:
8
c/o
left sided chest pain since 8:00am
with sweating and backache ,one
episode of vomiting

9. Objective evidence
Ck Mb Test Found To Be Positive
ECG :S-T segment elevation

10. ASSESSMENT
• As per subjective and objective evidence the patient
was diagnosed as S-T segment elevated Myocardial
Infraction(STEMI)

11. goals of the therapy :
SHORT TERM GOALS :
 relief of symptoms.
LONG TERM GOALS :
 prevent the complications
 improve the quality of life

12. Planning(DAY 1)
S. No Prescribed Drugs ROA FREQ DAY1 Indication
Trade Name Generic
Name
Dose
01. Inj STK STEPTOKINAS
E
1.5miu/100ml IV BD

fibrinolytic
02. Inj Heparin HEPARIN 25000miu/5ml IV For every
6hrs 
anticoagulant
03. Inj Rantac RANITIDINE 50mg IV TID

H2 blocker
04. Inj EMESET ONDANSETR
ON
2mg/ml IV BD

Anti emetic
06. Inj C-tri CEFTRIAXONE 1g IV BD

Antiboitic
cephalospori
n
07 Tab Ecosprin ASPIRIN 325mg ORAL STAT

antiplatelet
08 Tab CLOPITAB CLOPIDOGRE
L
300mg ORAL STAT

thienopyiridi
nes

13. CONT..Day 1 Treatment
S.
N
o
Prescribed Drugs Dose ROA FREQ DAY1
Trade Name Generic Name
09 Tab Atorva ATORVASTATIN 80mg ORAL STAT

10 Tab Isodnit ISO SORBIDE
MONOHYDRAT
E
10mg ORAL STAT

11 Tab Metaprolol METAPROLOL 200mg ORAL BD

12 IVF NS NORMAL
SALINE ,
1 pint IV OD

13

14. Day 2
Temperature : Afebrile
Pulse rate (/min) : 80bpm
Respiratory Rate : 26breaths/min
blood pressure : 110/70
ADV:
• CST(continue same treatment)
18

15. Day 3
Temperature (oF): febrile
Pulse rate (/min): 80
Respiratory Rate (/min): 26
BP(mm of Hg):110/70
ADV:
• CST...
19

16. Day 4
Temperature (oF): Afebrile
Pulse rate (/min): 86
Respiratory Rate (/min): 26
BP(mm of Hg):100/70
ADV:
• CST...
• ECG
16

17. Day 5,6
Temperature (oF): Afebrile
Pulse rate (/min): 86
Respiratory Rate (/min): 26
BP(mm of Hg):100/70
ADV:
• CST...
17

18. Monitoring parameters
DRUG RELATED:
DRUG <> DRUG
1. HEPARIN X STK (MAJOR): STK enhances the action of heparin ,
increases thromboplastic time
Management : heparin dosage should be adjusted as appropriate to
maintain the therapeutic thromboplastic time value and pt should be
carefully monitored for signs of bleeding
2. Stk X clopidogrel (MODERATE) : clopidogrel may increase the risk of
bleeding when administered prior to , during , after thrombolytic therapy
Management : carefully monitoring for signs of bleeding

19. CONTd…
3. HEPARIN X ASPIRIN (MODERATE) : may increase the risk
of bleeding
Management :close clinical and laboratory observations for
bleeding complications are recommended
4. Stk X ASPIRIN (MODERATE) : STK may increase the risk of
bleeding when administered prior to , during , after
thrombolytic therapy
Management : carefully monitoring for signs of bleeding

20. DISCHARGE MEDICATION
SL.NO DRUGS DOSE ROA FREQUENCY
1. TAB.ASPIRIN 150mg Oral OD
2. TAB.CLOPIDOGREL 75mg Oral OD
3. TAB.ATORVASTATIN 40mg Oral HS
4. TAB.METOPROLOL 200mg Oral BD
5. TAB.ISOSOBIDE
MONONITRATE
10mg Oral SOS

21. PATIENT COUNSELING
About the disease
mi results from sudden interruption of blood supply to area of myocardium
due to complete or near complete occlusion of coronary artery .
Risk factors:
 AGE
 TOBACCO
 HIGH BLOOD PRESSURE
 HIGH BLOOD CHOLESTEROL , ATHEROCLEROSIS
 DIABETES
 FAMILY HISTORY OF HEART ATTACK
 OBESITY
21

22. Contd..
About medications:
• T.Aspirin:Antiplatelet drug taken once daily
Common ADRs:bronchospasm,GIT haemmorhage,GIT irritation
• T.Clopidogrel:75 mg once daily
Common ADRs:abdominal pain,intracranial
haemmorhage,diarrhoea…
• T.Atorvastatin: half strength at bed time once daily
Common ADRs:weight gain,hyperglycemia,chestpain..
• T.Metoprolol: beta blocker,Taken twice daily
Common ADRs: tiredness ,nausea,vomiting…