presented by- dhaivat joshi (final year b.pharmacy) hari om pharmacy college

PRESENTED BY-Dhaivat Joshi

(FINAL YEAR B.PHARMACY)

Hari Om Pharmacy CollegeAt. Ambav, Ta. Thasra, Dist. Kheda.

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PATIENT DETAILSNAME: XYZ AGE: 61year

WEIGHT: 75 kg INPATIENT No:68129

ADDRESS: BARODA

HOSPITAL NAME: BARODA HEART INSTITUTE AND RESEARCH CENTER, BARODA

D.O.A: 06/12/2007

CONSULTANT NAME: Dr. PANKAJ VYAS (M.D,D.M)

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• SOCIAL HISTORY: VegetarianSOCIAL HISTORY: Vegetarian

• FAMILY HISTORY: Father had cardiac problem.FAMILY HISTORY: Father had cardiac problem.

• DIAGNOSIS : Ischemic heart disease andDIAGNOSIS : Ischemic heart disease and obesityobesity

• ASSOCIATED DISEASE: NoneASSOCIATED DISEASE: None

• PAST MEDICATION HISTORY: NilPAST MEDICATION HISTORY: Nil

• COMPLAINTS: CHEST PAIN, COMPLAINTS: CHEST PAIN, HEAVYNESS HEAVYNESS

HAEMATOLOGY TEST RESULT NORMAL RANGE

HAEMOGLOBIN 10.0g/dl M-13-17, F-12-15

RBC Count 3.40mill/ cmm M-4.1-5.5, F-3.7-5.0

P.C.V. 30.3% 39-54

M.C.V. 89.12fl 83-92

M.C.H. 29.41pg 27-34

M.C.H.C. 33% 30-36

R.D.W.-D 14.6fl 12.0-17

WBC Count 8000/ cmm 4000-10,000

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DIFFERENTIAL WBC COUNT WBC RESULT NORMAL RANGE

NEUTROPHILS 64% 40-70

LYMPHOCYTES 34% 20-40

EOSINOPHILS 01% 1-6

MONOCYTES 01% 1-8

BAND CELL ----- -----

BASOPHILS ----- -----

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ESR- 1hr( Westerngreen Method) :- 28mm/hr (normal range – M-1-7, F-2-10)

BLOOD Group:- ‘A’ Rh Factor:- POSITIVE Platelet Count:- 165000/ cmm (1,50,000-

4,00,000)

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BIOCHEMISTRY TEST RESULT NORMAL RANGE

RANDOM PLASMA GLUCOSE

92mg/dl 70-140

SERUM CREATININE 1.40mg/dl 0.4-1.4

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COAGULANT TESTTEST

PROTHROMBIN TIMERESULT NORMAL RANGE

PROTHROMBIN TIME(TEST)

29.8secs 10-15

PROTHROMBIN TIME(CONTROL)

30.0secs 0-0

PROTHROMBIN RATIO

0.99% -

PROTHROMBIN INDEX 100.67% 70-4.5

INR 0.99 2.5-4.5

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ESTIMATION OF SERUM ELECTROLYTEMETHOD – AUTOMATIC AVL 9130 ELECTROLYTE ANALYZER

ELECTROLYTE REPORTED COUNT

NORMAL COUNT

SODIUM 135-4mEq/L 135 –145 mEq/L

POTASSIUM 4-06mEq/L 3.5-5.5mEq/L

CHLORIDES 92mEq/L 97-106mEq/L

ESTIMATION OF BLOOD SUGAR POST LUNCH {GOD-POD}

SUGAR AFTER 2 HRS OF LUNCH

120md/ml 125mg/ml

SECTOR ECHOCARDIOGRAPHY Ischemic Heart Disease Hypokinesia of Basal and Mid Inferior segments LV show concentric hypertrophy All cardiac chamber are normal in dimentions. LV systolic function is normal at rest [ LV EF-56%] E/o regional wall motion abnormality at rest. Cardiac valves are normal in structure & cxcursions. RVOT & MPA are normal, NO e/o mass/clot seen.

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COLOUR FLOW, CW, PW &HAEMODYNAMIC DATA Normal flow across all cardiac valves. LV diastolic dysfunction. No MR/ TR. trivial AR. No E/O Lt--> Rt shunt

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CONCLUSION Ischemic Heart Disease. Good LV systolic function. Concentric LVH with diastolic dysfunction. E/o resting regional wall motion abnormality. Mildly Sclerosed AV with Trivial AR. Normal PA

Pressures.

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MEDICATIONS:-DRUG NAME DOSAGE FORM DOSE USES

Cardace(ramipril)

Cap -2.5mg 1-tab in morning As Vasodilator to reduse b.p.

Clodrel-foret(clopidogrel+aspirin)

Tab-75+162-5mg 1-tab after lunch Inhibit platelet aggregation

Atocor(atorvastatin)

Tab-10mg 1-tab at bed time Decrees cholesterol level

Ecosprin (aspirin)

Tab-150mg 1-tab after lunch Inhibit platelet aggregation

Pantodac(Pantoprazole)

Tab-40mg 1-tab before meal Antacid

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DRUG INTERACTION ATOCOR [ATROVASTATIN] = 10-20mg

DONOT CONSUME WITH ALCOHOL, IF HEPATIC INSUFFICIENCY,COLESTIPOL, ANTACID, DIGOXIN ERTHROMYCIN.

CARDACE [RAMIPRIL] =1-5-5mg

DO NOT TAKE WITH NSAID’S AS IT REDUCES ITS ACTIVITY. CLODREL-FORTE [CLOPIDOGREL+ASPIRIN] = 75+162.5mg

DIGOXIN ,WARFARIN & WITH NSAIDS INCRESS G.I.T. BLOOD LOSS.

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TO AVOID… FASTING REFINED FLOUR LIKE MAIDA,SAGO. NUTS,WALNUTS,CASHEW,GROUNDNUT,PANEER,BUTTER. CANNED/TINNED FOOD. POTATO,BEETROOT,YAM,SAGO,RAW BANANA,SURAN. EGG YOLK. FAST FOOD/ AREATED DRINKS RICE AT DINNER TIME SWEET PRODUCTS WITH EXCESS GHEE. MUTTON,BEEF,PORK. ALCOHOL/ SMOKING/ TOBACCO AFTERNOON SLEEP.

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PREFER… WALK AT MORNING & NIGHT. HAVING FOOD AT RIGHT TIME 6 MEALS A DAY TO AVOID HYPOGLYCEMIA. CARRY SWEET IN POCKET TO AVOID HYPOGLYCEMIC STROKE. SKIMMED MILK. CONSUME MORE SALAD & VEGETABLE ONLY EGG WHITE OIL USE MUST NOT EXCEED(15gm)/DAY/PERSON. REGULAR EXERCISE. UNREFINED CARBOHYDRATE HAVE WHOLE FRUIT. REGULAR CHECK UP.

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PATIENT COUNSELLING EXPLAIN THE SIGNS AND SYMPTOMS OF CIRCULATORY EVENTS

CAUSE BY A TIGHT CAST THAT REQUIRES IMMEDIATE TREATMENT. DISSCUSS THE SIGNS AND SYMPTOMS OF EVENTS. TEACH THE PATIENT CAUSE OF ARM PAIN & TREATMENT. WEIGHT SHOULD BE CONTROLED. PATIENT IS REQUEST NOT TO ALTER DOSE OR CHANGE THE

DOSAGE FORM PATIENT SHOULD DUELY VISIT DOCTOR AND HAVE THEIR LIPID &

OTHER CONCERNE PROFILE UP DATEDED. DONOT PULL OR PUSH ANY HEAVIER LOAD. NO BRISK WALKING. YOGA EXERCISE SHOULD NOT INCLUDE EXTENSIVE STRECHING

OR UPSIDE DOWNING.

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REFERENCES:-

www.indiamediworld.com

www.drugdigest.com

Tripathi K.D, 2004 “ Essential Of Medical Pharmacology”, 5th Edition , Jaypee Publication Page No: 465,567,444 Drug Today, Vol-1&2, Ready reckner of current medical formulations, pg no-256,1264,271,717.

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