This powerpoint deals with Coronary Artery Disease, mentioning a few details into the disease & explaining the SOAP format of a patient having this disease(in short). Regards, @ RxVichu! :)

1. SOAP ANALYSIS ON
CORONARY ARTERY
DISEASE
BY : VISHNU.R.NAIR
4TH YEAR PHARM.D
NATIONAL COLLEGE OF PHARMACY

2. PROBLEMS LIST:
• CAD(CORONARY ARTERY DISEASE)
• SVD(SINGLE VESSEL DISEASE)

3. GENERAL INTRODUCTION TO ATHEROSCLEROTIC CAD:
• “Condition, in which ATHEROSCLEROTIC CHANGES are present within the WALLS of
CORONARY ARTERIES”
• Also known as “CORONARY ARTERY ATHEROSCLEROSIS”
• Principal cause of CAD, which is the single largest killer of men and women in the UNITED
STATES.
• Usually affects the arteries, that supply the heart with blood

4. ETIOLOGY OF CAD:
1. SMOKING
2. HIGH BLOOD PRESSURE
3. HIGH CHOLESTEROL LEVELS
4. DIABETES MELLITUS, OR INSULIN RESISTANCE
5. SEDENTARY LIFESTYLE

5. RISK FACTORS FOR CAD:
1. AGE:
- Getting older increases your risk of damaged and narrowed arteries
2. SEX:
- Men are generally at higher risk of CAD
- Risk for women increases after MENOPAUSE
3. FAMILY HISTORY:
- Family history of heart disease is associated with a higher risk of CAD(especially if a close
relative developed heart disease at an early age)
- Risk could be highest if your father or brother was diagnosed with heart disease BEFORE
AGE 55, / if your mother/ sister developed it before AGE 65

6. 4. SMOKING:
- People who smoke have a significantly increased risk of heart disease
- Exposing others to your second hand smoke also increases their risk of CAD
5. HIGH BLOOD PRESSURE:
- Uncontrolled high B.P  Hardens and thickens arteries  narrows the channel through
which blood can flow
6. HIGH BLOOD CHOLESTEROL LEVELS:
- High cholesterol levels  increases risk of plaques formation and subsequent atherosclerosis
- High cholesterol can be caused by a high level of LDL
- Low levels of HDL can also trigger atherosclerosis
7. DIABETES:
- DM  associated with increased risk of CAD

7. 8. OVERWEIGHT / OBESITY:
- Excess weight  typically worsens other risk factors  leads to CAD
9. PHYSICAL INACTIVITY:
- Lack of exercise  associated with CAD and some of its risk factors as well
10. HIGH STRESS:
- Unrelieved stress in life  damages arteries , and also worsens other risk factors for CAD
11. SLEEP APNEA:
- “Disorder, in which person repeatedly STOPS AND STARTS BREATHING, while in SLEEP”
- Sleep apnea  causes sudden drops in blood oxygen levels  increases B.P  Strains CVS 
Leads to CAD
12. HIGH SENSITIVITY CRP:
- hs-CRP  protein , that appears in high amounts , when there is inflammation somewhere in the
body
- High hs-CRP levels  good risk factor for heart disease, since it is believed that as coronary arteries
narrow, you will have more hs-CRP in your blood

8. 13.HOMOCYSTEINE:
- Amino acid, that our body uses to make protein , and to build and maintain tissue
- High levels of homocysteine  increases CAD risk

9. CLINICAL MANIFESTATIONS:
1. Angina pectoris
2. Chest pain (due to lack of oxygen)
3. Palpitations
4. Dyspnea
5. Syncope
6. Excessive fatigue
7. Anxiety
8. Hemoptysis
9. Dizziness
10. Nausea and vomiting
11. Chest-tightedness

10. COMPLICATIONS:
• CHEST PAIN (ANGINA)
• HEART FAILURE
• HEART ATTACK
• ABNORMAL HEART RHYTHM (ARRHYTHMIA)

11. MANAGEMENT STRATEGIES FOR CAD:
A. GOALS OF THERAPY:
- To relieve CAD symptoms
- To prevent progression into complications
- To reduce morbidity and mortality
- To improve QOL

12. B. PHARMACOTHERAPY:
Drugs used include:
I. STATINS:
- Atorvastatin - Pravastatin - Simvastatin - Rosuvastatin
- Pitavastatin - Lovastatin - Fluvastatin
II. PCSK-9 INHIBITORS:
- Alirocumab - Evolocumab
III. CCBs:
- Amlodipine - Nifedipine - Verapamil - Felodipine
- Diltiazem
IV. ACE-INHIBITORS:
- Ramipril - Quinapril - Captopril - Enalapril
- Lisinopril

13. V. PLATELET AGGREGATION INHIBITORS:
- Clopidogrel
- Aspirin
- Abciximab
VI. FIBRIC ACID DERIVATIVES:
- Fenofibrate
- Gemfibrozil
VII. BILE ACID SEQUESTRANTS:
- Colestipol
- Cholestyramine
VIII. ANTI-OXIDANTS:
- Vitamin E

14. IX. NICOTINIC ACID DERIVATIVES:
- Niacin
X. ANTI-ANGINALAGENT:
- Ranolazine
C. NON-PHARMACOTHERAPY:
1. CORONARY REVASCULARIZATION with CABG/ PCI
2. PTCA
3. Partial ileal bypass
4. Plethysmography/ extracorporeal counterpulsation
5. Diet and lifestyle modifications

15. SUBJECTIVE:
A. PATIENT DETAILS:
- NAME: Mr. X
- AGE : 46 years
- SEX : Male
- WEIGHT : 95 kgs
- HEIGHT : 180 cm
- BMI : 29.32
- I.P No. : 193636
- DEPARTMENT : Cardiology
- DOA : 24/9/16 - DOD : 27/9/16

16. B. REASON FOR ADMISSION:
- The patient had C/O:
a. Neck pain
b. Shoulder pain
c. Pain in the hands
d. Chest discomfort
e. Chest- tightedness
C. PATIENT MEDICAL HISTORY :
- HTN
- Angioplasty done at MIMS

17. D. PATIENT MEDICATION HISTORY :
- Patient took Tablet TELVAS 20 ( For 6 years)
E. KNOWN ALLERGIES:
- Patient is allergic to dust
F. FOOD HABITS:
- Patient is non-vegetarian
G. SOCIAL HABITS:
- Patient was an ex-smoker
- Stopped smoking 6 months ago
- Non-alcoholic

18. OBJECTIVE:
DATE 24/09/2016 25/09/2016 26/09/2016 27/09/2016
TEMPERATURE(i
n degree
Fahrenheit)
98.6 98.6 98.6 98.6
B.P (in mm of
Hg)
120/70 110/80 140/80 130/90
PULSE (in
beats/minute)
60 60 74 70
RBS (in mg/dl) 95
RR ( in
breaths/min)
18 13 22 22

19. BLOOD COUNTS:
Hemoglobin : 14.4 mg/dl Blood group : A(+ve)
RENAL FUNCTION TESTS(RFTs):
- UREA: 18.3 mg % (checked on 24/08/2016)
- URIC ACID : 6.22 mg/dl (checked on 25/08/2016)
- SERUM CREATININE : 1.56 mg % (checked on 24/08/2016)
ELECTROLYTES:
- SODIUM: 143 mEq/L
- POTASSIUM : 3.9 mEq/L
- CALCIUM: 10.4 mEq/L

20. OTHERS:
ECHO showed concentric LVH, no RWMA, good LV function, trivial TR, and no PAH

21. ASSESSMENT:
DIAGNOSIS:
1. CAD
2. SVD
ETIOLOGY:
1. Smoking (patient was an ex-smoker)
2. HTN (as co-morbid condition, which can lead to narrowing and hardening of arteries,
leading to CAD )
ASSESSMENT IF THERAPY INDICATED (GOALS OF THERAPY):
To treat conditions of CAD,SVD using appropriate medications; and to improve QOL

22. ASSESSMENT OF CURRENT THERAPY:
1. INJ. HEPARIN (HEPARIN) 5000 IU Q6H i.v (D1-D4):
- Anti-coagulant
- Drug  inactivates Factor Xa and inhibits conversion of prothrombin to thrombin (low
dose)
- Drug  inactivates factors IX,X,XI and XII and thrombin ;and inhibits conversion of
fibrinogen to fibrin (high dose)
2. INJ. PAN (PANTOPRAZOLE) 40 mg i.v OD (D1-D4) :
- Proton pump inhibitor
- Drug  binds to H+/K++ ATPase(proton pump) in gastric parietal cells  blocks proton
pump  prevents acid secretion
3. T.ECOSPIRIN (ASPIRIN) 150 mg P/O 0-1-0 (D1-D4):
- Drug  inhibits COX pathway  inhibits PG synthesis
- Drug  also inhibits platelet aggregation
- Anti-platelet drug

23. 4.T.PLAVIX (CLOPIDOGREL) 75 mg P/O 1-0-1 (D1-D4):
- Drug  blocks ADP  inhibits ADP-induced pathway for platelet aggregation
- Anti-platelet drug
5. T.PROLOMET XL (METOPROLOL) 25 mg P/O 1-0-0 (D1-D4):
- Anti-hypertensive , beta-1- blocker
- Drug  blocks response to beta-adrenergic stimulation  causes reduction in B.P  anti-
hypertensive effect
6. T. ROSEDAY (ROSUVASTATIN) 40 mg P/O 0-0-1 (D1-D4):
- HMG CoA Reductase inhibitor; anti-hyperlipidemic
- Drug  blocks the rate limiting step in cholesterol biosynthesis
7. T.GTN SORBITRATE (GLYCERYL TRINITRATE ) 2.6 mg P/O 1-
0-1 (D1-D4):
- Drug  enters body  converted into NO(active intermediate compound)  stimulates guanylate
cyclase  stimulates synthesis of CYCLIC GMP  Activates series of protease kinase dependant
phosphorylation in smooth muscle cells  dephosphorylation of myosin light chain of smooth muscle
cells  causes release of calcium ions  causes relaxation of smooth muscle , vasodilation.

24. 8. T. TELVAS (TELMISARTAN) 20 mg P/O 0-0-1 (D1-D4):
- Angiotensin receptor blocker, ANTI-HYPERTENSIVE
- Drug  blocks ANGIOTENSIN RECEPTOR- II  inhibits vasoconstrictor and
aldosterone secreting effects of angiotensin II
9. T. TRIKA (ALPRAZOLAM) 0.25 mg P/O HS (D1-D4):
- Anxiolytic, Benzodiazepine, Sedative
- Used to induce sleep, to counteract disease and its manifestations induced sleep
impediments
10. SYRUP. CREMAFFIN PLUS (LIQUID PARAFFFIN+
MAGNESIUM HYDROXIDE + SODIUM PICOSULFATE ) 30
ml. P/O HS (D1-D4):
- CATHARTICS/ LAXATIVES/ STOOL SOFTENERS
- Used for stool softening, against constipation

25. DRUG DOSE ROUTE OF
ADMINISTRA
TION
FREQUENCY 24/08/2016 25/08/2016 26/08/2016 27/08/2016
INJ.HEPARIN 5000 IU I.V Q6H Y Y Y Y
INJ.PAN 40 mg I.V OD Y Y Y Y
T. ECOSPIRIN 150 mg P/O BD Y Y Y Y
T.PLAVIX 75 mg P/O BD Y Y Y Y
T.PROLOMET
XL
25 mg P/O OD Y Y Y Y
T.ROSEDAY 40 mg P/O OD Y Y Y Y
T. GTN
SORBITRATE
2.6 mg P/O OD Y Y Y Y
T. TRIKA 0.25 mg P/O OD (HS) Y Y Y Y
SYRUP
CREMAFFIN
PLUS
30 ml. P/O OD(HS) Y Y Y Y
PLAN :

26. T.TELVAS 20 mg P/O OD Y Y Y Y

27. PROGRESS CHART:
24/08/2016:
- Patient had complaints of neck, shoulder and hand pain , along with chest discomfort and
tightedness
- Vitals were found to be normal
- Echo was done , which revealed concentric LVH, no RWMA, good LV function , trivial TR,
and no PAH
25/08/2016:
- No pallor, icterus, clubbing, cyanosis, lymphadenopathy / edema
- Chest clear
26/08/2016:
- No fresh complaints
- chest clear
- GIT is soft and non- tender

28. • 27/08/2016:
- No fresh complaints
- Chest clear
- Patient felt better and was discharged appropriately.

29. DISCHARGE SUMMARY:
- A 46 year old male, with past medical history of HTN, was admitted to the cardiology
department, with c/o neck and shoulder pain, chest tightedness and discomfort.
Angioplasty was done on him at MIMS. Echo showed concentric LVH, no RWMA,
trivial TR and no PAH. He was diagnosed to have CAD, with SVD. He was treated with
HEPARIN, ANTI-PLATELETS & other supportive measures. He improved
symptomatically, and was discharged in clinically stable condition.
DISCHARGE MEDICATIONS:
1. T. ECOSPIRIN 150 mg 0-1-0 Advised to have low fat diet, with restricted
2. T. PLAVIX 75 mg 1-0-1 physical activity.
3. T. AZTOR 40 mg 0-0-1
4. T. GTN SORBITRATE 2.6 mg 1-0-1
5. SYP.CREMAFFIN HS 30 ml.
6. T. PAN 1-0-0 (B/F).
7. T. TELVAS (20 mg P/O) 0-0-1.

30. DRUG RELATED COUNSELLING:
• Atorvastatin should be consumed at night, to facilitate pharmacological activity.

31. DISEASE RELATED COUNSELLING:
• Avoid stress
• Avoid high-fat, high-oily and fast foods
• Control HTN properly, to avoid worsening of CAD
• Focus on consumption of leafy vegetables and dry fruits.

32. THANK YOU !!