Case presentation on

Myocardial infraction

presenting by :n.Satyavardhan rao Pharm.d 2nd year

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

demographic details:

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

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physical examinationVital signs:

Temperature : Afebrile Pulse rate : 80bpmRespiratory Rate : 18breaths/min Blood Pressure : 120/70 mmHg

ADV: CBC with ESR Chest x-ray, ECG s LFT , RFT , RBS , Serum electrolytes

PAST HISTORY:PAST MEDICATION:NILPAST MEDICAL HISTORY:NIL FAMILY HISTORY: NSSOCIAL HISTORY: NSALLERGIES: NKA

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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

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provisional diagnosis: myocardial infraction

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SOAP Subjective evidence:

c/o left sided chest pain since 8:00am

with sweating and backache ,one episode of vomiting

Objective evidence

Ck Mb Test Found To Be PositiveECG :S-T segment elevation

ASSESSMENT• As per subjective and objective evidence the patient

was diagnosed as S-T segment elevated Myocardial Infraction(STEMI)

goals of the therapy : SHORT TERM GOALS : relief of symptoms.

LONG TERM GOALS : prevent the complications improve the quality of life

Planning(DAY 1)S. No Prescribed Drugs ROA FREQ DAY1 Indication

Trade Name

Generic Name

Dose

01. Inj STK STEPTOKINASE

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 ONDANSETRON

2mg/ml IV BD Anti emetic

06. Inj C-tri CEFTRIAXONE 1g IV BD Antiboiticcephalosporin

07 Tab Ecosprin ASPIRIN 325mg ORAL STAT antiplatelet

08 Tab CLOPITAB CLOPIDOGREL

300mg ORAL STAT thienopyiridines

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CONT..Day 1 TreatmentS. No

Prescribed Drugs Dose ROA FREQ DAY1

Trade Name Generic Name

09

Tab Atorva ATORVASTATIN

80mg ORAL STAT 10

Tab Isodnit ISO SORBIDE MONOHYDRATE

10mg ORAL STAT 11

Tab Metaprolol

METAPROLOL 200mg ORAL BD 12

IVF NS NORMAL SALINE ,

1 pint IV OD

Day 2Temperature : AfebrilePulse rate (/min) : 80bpm

Respiratory Rate : 26breaths/min blood pressure : 110/70

ADV:• CST(continue same treatment)

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Day 3

Temperature (oF): febrilePulse rate (/min): 80

Respiratory Rate (/min): 26 BP(mm of Hg):110/70

ADV: • CST...

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Day 4

Temperature (oF): AfebrilePulse rate (/min): 86

Respiratory Rate (/min): 26 BP(mm of Hg):100/70

ADV: • CST...• ECG

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Day 5,6

Temperature (oF): AfebrilePulse rate (/min): 86

Respiratory Rate (/min): 26 BP(mm of Hg):100/70

ADV: • CST...

Monitoring parametersDRUG RELATED:

DRUG <> DRUG1. HEPARIN X STK (MAJOR): STK enhances the action of heparin , increases thromboplastic timeManagement : 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 therapyManagement : carefully monitoring for signs of bleeding

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 therapyManagement : carefully monitoring for signs of bleeding

DISCHARGE MEDICATIONSL.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

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PATIENT COUNSELING

About the diseasemi results from sudden interruption of blood supply to area of

myocardiumdue 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

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