- The patient, a 67-year-old female, presented with chest tightness, anxiety, left shoulder and hand pain, and weakness and was admitted to the hospital for angina pectoris. - Laboratory tests and a CT scan confirmed the diagnosis of angina pectoris and ruled out any significant coronary artery blockages. - The patient was treated with medications to relieve symptoms, lower blood pressure and cholesterol, and prevent complications. Her condition improved over 4 days and she was discharged on long-term medications with goals of managing her angina and cardiovascular risks.

1. A Case presentation on
Angina Pectoris
By,
Umme Habeeba A Pathan
Roll no: 27
Pharm-D 2nd year Bapuji
Pharmacy College

2. DEFINITION
• Angina is the result of myocardial ischemia caused by an imbalance
between myocardial blood supply and oxygendemand.
• It is medical term used for Retro sternal chest pain.

3. SUBJECTIVE
• NAME : XYZ
• AGE : 67 yrs
• SEX : Female
• IP No. : 16881
• UNIT : MED I
• DOA : 23/03/2018.

4. • REASONS FOR ADMISSION :
C/o chest tightness, anxiety, left shoulder and hand pain, weakness.
One day before admission she was severely dyspnic & distressed.
• PAST MEDICAL HISTORY : K/C/O hypertension
• PAST MEDICATION HISTORY: Under the treatment of Telmisartan since 10
years.
• FAMILY HISTORY: Father died due to heart attack at age of 40.
• ALLERGIES AND SOCIAL HISTORY: Nil

5. OBJECTIVE
O/E
• Weight : 86 kg
• BP : 130/90mmHg
• PR : 90bpm
• CVS : S1S2 +ve murmurs heard
• RS : B/L NVBS + ,
• CNS : Conscious and oriented
• Temperature : Afebrile

6. LAB INVESTIGATION
PARAMETERS OBSERVED VALUE NORMAL VALUE
Hb 11.6g/dl 14 – 18g/dl
RBC 3.5 × 10⁶cells/mmᶟ 4.3 – 5.9 × 10⁶cells/mmᶟ
PCV 42 % 39 – 49 %
MCV 88 µmᶟ 76 – 100µmᶟ
MCH 21pg/cell 27 –33pg/cell
MCHC 25g/dl 33 – 37g/dl
PLATELET 135 × 10³/mmᶟ 130 – 400 × 10³/mmᶟ
TROPONIN LEVELS 0.2 ng / ml 0.1ng/ml
ESR 18mm in 1ᶳᵗ hour 0 – 20mm in 1ᶳᵗ hour
CRP 2.9mg/dl <3.0mg/dl
MYOGLOBIN LEVELS 78 ng / ml 10 – 65 ng / ml
CPK 110mcg/dl 10-120mcg/dl

7. LIPID PROFILE TEST
PARAMETERS OBSERVED VALUES NORMAL VALUES
Cholesterol 190mg/dl < 200mg/dl
Triglycerides 178mg/dl < 160mg/dl
LDL 140mg/dl < 130mg/dl
HDL 55mg/dl > 45mg/dl

8. CAC SCORE BY CT SCAN
PARAMETERS OBSERVED VALUE NORMAL VALUE
CORONARY CALCIUM SCORE 0 0 (Risk of CAD very low) 1-
10 (Risk of CAD low) 11-100
(Mild or minimal coronary
narrowing)
101-400 (Mild CAD highly
likely)
>400 (Highly likelihood of at
least 1 significant coronary
narrowing)

9. TECHNICAL INFORMATION: Multiple 2.5mm helical CT images of the heart
were obtained . The images were analyzed and scored for coronary calcium
content. Calcium scores were derived and reviewed. Number of images
reviewed 59.
INTEPRETATION :
TOTAL CALCIUM SCORE: 0
This total score is the amalgamation of calcium score in the left main
coronary artery, the left anterior descending coronary artery, the
circumflex coronary artery and the right coronary artery and their
branches. No significant calcium deposits were identified in any of these
major coronary artery distributions.
A total score of 0 indicates that no atherosclerotic plaque was identified,
and that the risk of significant underlying coronary artery disease is very
low.

10. ASSESSMENT
PROVISIONAL DIAGNOSIS OF ANGINA PECTORIS

11. GOALS OF TREATMENT
• Torelieve signs and symptoms of Angina.
• Torelieve the dyspnic condition of patient.
• Toprevent further complication of CAD.
• Toimprove the quality of life of patient.

12. PLAN
• DAY 1
DRUGS DOSE FREQUENCY MAX DOSE
IVF NS Q6h
TAB.Carvedilol 12.5mg 1-0-1 25mg
TAB. Aspirin 80mg 1-0-0 325mg
TAB. Capoten 12.5mg 1-0-1 25mg
TAB. Atorva 20mg 0-0-1 80mg
TAB. Omeprazole 20mg 0-0-1 40mg
TAB.FEOSOL
(ferrous sulphate)
300mg OD 400mg

13. DAY 2
PARAMETERS Rx
O/E
BP:130/85 mmHg
LDL:135mg/dl TriG:
175mg/dl
Troponin levels: 0.1ng/dl
CST
IVF STOPPED
DAY 3
PARAMETERS Rx
O/E
BP: 130/90mmHg LDL:
135mg/dl HDL:175mg/dl
Pt complain of constipation
CST
Add syp.lactulose
15ml PO

14. DAY 4
PARAMETERS Rx
O/E
BP: 120/85mmHg
CST
Patient dispnic
condition was
improved
DISCHARGE MEDICATION
DRUGS DOS
E
FREQUENC
Y
NO OF DAYS MAX DOSE
NIFEREX 150 –
Forte(Vit B12, Vit C ,
iron supplement)
5ml OD 15 days 10ml
TAB.ATAST(Atorvastatin) 10m
g
0-0-1 5 days 20mg
TAB.TELMISARTAN 20m
g
1-0-0 CONTINUE 80mg
VISIT AFTER 15 DAYS

15. GOALS ACHIEVED
• Retro sternal pain has been controlled.
• Signs and symptoms were reduced.
• Patients condition became better.

16. INTERACTIONS
• No major interactions were found.
• Moderate interactions include
Captopril <> Aspirin
Dose adjustment should be done as it decreases kidney function.
Omeprazole <> Fe multivitamin
omeprazole may reduce the absorption of iron multivitamin
Atorvastatin <> Omeprazole :
Combining these medications may increase the blood levels and may
increase the risks of side effects like liver damage.

17. MEDICATION INDICATION
• IVF NS is a fluid replenisher.
• Tab.Carvedilol is to treat BP and improve the chance of survival when
heart is not pumping well.
• Tab. Aspirin is used as an anti-platelet agent and for the treatment of
chest pain.
• Tab. Capoten is used to treat high BP and help the heart to pump blood
well as it did before.
• Tab. Atorvastatin is an HMG-Co A reductase inhibitor used in the
treatment of cardiovascular diseases.
• Tab .Omeprazole is a proton pump inhibitor & inhibits the secretion of
gastric acid.
• Tab. Feosol (ferrous sulphate) is an iron supplement used for treatment of
low blood levels of iron.
• Syp.lactulose is given to treat constipation.
• Tab.captopril is used to treat hypertension.

18. PATIENT COUNSELLING
o ABOUT MEIDICATIONS
• T
akemedicines prescribed properly, don’t refill prescription unless advised.
• Inform physician for any side effects.
• Don’t double the dose if missed.
o ABOUT DISEASE
• Periodic screening for hypertension and other cardiac risks.
• Educating patient about the risks leading after an attack of angina.
o ABOUT LIFESTYLE MODIFICATION
• Drink lots of water.
• Low physical activity.
• Take iron rich balanced diet.
• Adequate fluid intake.
• Avoid excess salt & FATTY intake.

19. THANK YOU