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CASE PRESENTATION
ON
‘ACUTE MYOCARDIAL INFARCTION’
Presented by: Netal Patel (09)
Pharm D. 2nd Year
ABOUT THE DISEASE
• Myocardial infarction (MI) is a medical term
for heart attack. It is the necrosis (irreversible
death) of the heart muscle secondary to
prolonged lack of oxygen supply that is
Ischemia.
SUBJECTIVE EVIDENCE
• Name: Mr. ABC
• Age: 65Yrs
• Gender: Male
• Patient IP Number: 18013567
• Department: Male Medicine Ward
• Unit: III
SUBJECTIVE EVIDENCE
Reasons for admission:
C/o
• Chest Pain at midnight relieved by 1:00 am
• Chest Burning at the time of admission
• Discomfort and Restlessness
HISTORY
• Past Medical History: No History
• Social History: Smoking since very long time
• Family History: NA
• Allergies: NA
OBJECTIVE EVIDENCE
• General: Average Built
• CVS: S1S2 heard
• RS: AeBe clear
• CNS: Conscious, Oriented
• P/A: Soft,Non tender
• BP: 130/70mmHg
• P: 105 B/min
• Temp: 98°F
LAB INVESTIGATIONS
Component Patient Results Standard Range Units
Hb 14.1 (11.5-18) gm%
WBC 10.22
(4-11x10^3)
)
Nos
Neutrophils 78 (40-70) %
Eosinophils 1 (1-6) %
Lymphocytes 18 (20-40) %
Monocytes
3 (2-10) %
Basophils 0 (0-1) %
RBC 3.84
M(4.5-6x10^12)
F(3.8-5.8x10^12)
Nos
Platelets 2.95 (1.5-4x10^5) Nos
PCV 43.4 (40-54) %
MCV 113.1 (78-100) fL
MCH 36.7 (27-31) pg
‣ COMPLETE BLOOD COUNT (HEMATOLOGY) (DAY 1- 25/07/18)
LAB INVESTIGATIONS
‣ LIVER FUNCTION TESTS (DAY 1- 25/07/18)
Component Patient Results Standard Range
ALT/SGPT 18 Upto 40IU/L
‣ SERUM ELECTROLYTE TESTS (DAY 1- 25/07/18)
Component Patient Results Standard Range
Na+ 130 130-145mEq/L
K+ 4.2 3-5mEq/L
Cl- 98 98-106mEq/L
Ser. Creatinine 0.8 Unto 1.5 mg/dL
LAB INVESTIGATIONS
‣ TROPONIN DETECTION (DAY 1- 25/07/18)
Component Result
S. Troponin-I Weak Positive
‣ 2-D ECHO (DAY 1- 25/07/18)
Conclusion: Ischaemic heart disease involving LAD territory.
‣ LIPID PROFILE (DAY 1- 25/07/18)
Component Patient Results Standard Range
S. Cholesterol 225 <200 mg/dl
S. LDL 158.1 <100 mg/dl
ASSESSMENT
• Provisional Diagnosis:
‘Myocardial Infarction’.
JUSTIFICATION
• A 65 year old male patient was admitted to
Medicine ward-3 with complaints of chest pain
at night, heartburn, discomfort and
restlessness.
• Based on lab report patient had symptoms of
Heart attack ie. radiating chest pain for more
than 15 minutes. The CBC was abnormal,
Troponin I weakly positive and 2D Echo
suggested that the patient had CAD with LAD
blockage.
FINAL DIAGNOSIS
‘Acute Myocardial Infarction’
GOALS OF TREATMENT
• Relieve or reduce restlessness and heartburn.
• Improve patient’s quality of life.
• Prevent or minimise hospitalisations for further chances of
Heart Failure.
• Reduce future complications associated with
cardiovascular system.
• Slow the progression of disease and prolong survival.
PLANNING: DAY-1(ICU)
Brand Name Generic Name
Route of
Admin.
Dose Frequency Indication
Inj. Pantocid Pantoprazole IV 40mg BD
Treatment
of Acidity
Inj. Emeset Ondansetron IV 4mg TDS
Nausea,
Vomitting
Inj. Clexone Enoxaparin SC 40mg BD
Prevents
Thrombosis
Inj. Lasix Furosemide IV 40mg SOS
Oedema
and High
BP
Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD
Prevents
blood clot
Tab. Clopitab Clopidogrel Oral 75mg OD
Prevents
blood clot
Tab. Atorva Atorvastatin Oral 40mg OD
High
cholesterol
Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
DAY-1(ICU)
• Fresh complaint: Chest pain
• Tablet prescribed for Complaint:
‣ Add Tab. ISMO 10mg BD and Tab. Met-XL 25mg
• Vitals:
• Advice:
‣ CBC
‣ Creatinine
‣ Na+, K+
‣ SGPT
‣ 2-D Echo
‣ Troponin-I
Temperature
CNS: Conscious, OPA:
Tenderness
98°F
Pulse 90/min
Respiration 24/min
BP 120/80 mmHg
SPO2 99%
‣ Lipid Profile
PLANNING: DAY-2(ICU)
Brand Name Generic Name
Route of
Admin.
Dose Frequency Indication
Inj. Pantocid Pantoprazole IV 40mg BD
Treatment of
Acidity
Inj. Emeset Ondansetron IV 4mg TDS
Nausea,
Vomitting
Inj. Clexone Enoxaparin SC 40mg BD
Prevents
Thrombosis
Inj. Lasix Furosemide IV 40mg SOS
Oedema and
High BP
Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD
Prevents blood
clot
Tab. Clopitab Clopidogrel Oral 75mg OD
Prevents blood
clot
Tab. Atorva Atorvastatin Oral 40mg OD
High
cholesterol
Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
Syp. Cremoffin
Sodium Picosulphate +
Soft Paraffin + Milk of
Magnesia
Oral
3.33mg + 1.25ml
+ 3.75ml
HS Constipation
Tab ISMO
Isosorbide
Oral 10mg BD Chest Pain
DAY-2(ICU)
• Vitals:
• Advice:
‣ 2-D Echo
‣ Daily ECG
‣ Continue same treatment
Temperature
CNS: Conscious,
OPA: Tenderness
97°F
Pulse 70/min
Respiration 16/min
BP 110/70 mmHg
‣ THYROID FUNCTION TEST (DAY 2- 26/07/18)
Component Result Standard Range
TSH (2nd Gen) 0.84 0.3-5.0 uIU/mL
‣ Change Pantocid toTablet
‣ Stop Emeset
PLANNING: DAY-3,4,5(ICU)
Brand Name Generic Name
Route of
Admin.
Dose Frequency Indication
Tab. Pantocid Pantoprazole Oral 40mg BD
Treatment of
Acidity
Inj. Clexone Enoxaparin SC 40mg BD
Prevents
Thrombosis
Inj. Lasix Furosemide IV 40mg SOS
Oedema and
High BP
Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD
Prevents blood
clot
Tab. Clopitab Clopidogrel Oral 75mg OD
Prevents blood
clot
Tab. Atorva Atorvastatin Oral 40mg OD
High
cholesterol
Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
Syp. Cremoffin
Sodium Picosulphate +
Soft Paraffin + Milk of
Magnesia
Oral
3.33mg + 1.25ml
+ 3.75ml
HS Constipation
Tab ISMO
Isosorbide
Mononitrate
Oral 10mg BD Chest Pain
Tab Met-XL Metoprolol Succinate Oral 25mg OD
Chest Pain,
DAY-3,4,5(ICU)
• Vitals:
• Advice:
‣ Daily ECG
‣ Continue same treatment
‣ Shift the patient to General Medicine Ward
‣ Add Tab. Torvasan-F
‣ Stop Clexone
Temperature
CNS: Conscious, OPA:
Tenderness
98°F
Pulse 96/min
Respiration 24/min
BP 120/80 mmHg
SPO2 99%
PLANNING: DAY-6,7
Brand Name Generic Name
Route of
Admin.
Dose Frequency Indication
Tab. Pantocid Pantoprazole Oral 40mg BD
Treatment of
Acidity
Inj. Lasix Furosemide IV 40mg SOS
Oedema and
High BP
Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD
Prevents blood
clot
Tab. Clopitab Clopidogrel Oral 75mg OD
Prevents blood
clot
Tab. Atorva Atorvastatin Oral 40mg OD
High
cholesterol
Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
Syp. Cremoffin
Sodium Picosulphate +
Soft Paraffin + Milk of
Magnesia
Oral
3.33mg + 1.25ml
+ 3.75ml
HS Constipation
Tab ISMO
Isosorbide
Mononitrate
Oral 10mg BD Chest Pain
Tab Met-XL Metoprolol Succinate Oral 25mg OD
Chest Pain,
High BP
Tab Torvasan-F
Atorvastatin+Fenofibrat
Oral 10mg+160mg OD
High
DAY-6,7
• Vitals:
• Advice:
‣ Daily ECG
‣ Add Tab Folvite 5mg , Mbson-SL
‣ CBC, Liver FT, Electrolytes
Temperature
CNS: Conscious, OPA:
Tenderness
98°F
Pulse 78/min
Respiration 18/min
BP 130/80 mmHg
SPO2 97%
Component Patient Results Standard Range Units
Hb 11.6 (11.5-18) gm%
WBC 6320
(4-11x10^3)
)
Nos
Neutrophils 63 (40-70) %
Eosinophils 1 (1-6) %
Lymphocytes 32 (20-40) %
Monocytes
4 (2-10) %
Basophils 0 (0-1) %
RBC 3.14
M(4.5-6x10^12)
F(3.8-5.8x10^12)
Nos
Platelets 2.95 (1.5-4x10^5) Nos
PCV 35.5 (40-54) %
MCV 113.0 (78-100) fL
MCH 36.9 (27-31) pg
‣ COMPLETE BLOOD COUNT (HEMATOLOGY) (DAY 7- 31/07/18)
‣ LIVER FUNCTION TESTS (DAY 7- 31/07/18)
Component Patient Results Standard Range
ALT/SGPT 23 Upto 40IU/L
‣ SERUM ELECTROLYTE TESTS (DAY 7- 25/07/18)
Component Patient Results Standard Range
Na+ 131 130-145mEq/L
K+ 4.3 3-5mEq/L
Cl- 99 98-106mEq/L
Ser. Creatinine 0.9 Unto 1.5 mg/dL
PLANNING: DAY-8
Brand Name Generic Name
Route of
Admin.
Dose Frequency Indication
Tab. Pantocid Pantoprazole IV 40mg BD
Treatment of
Acidity
Inj. Lasix Furosemide IV 40mg SOS
Oedema and
High BP
Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD
Prevents blood
clot
Tab. Clopitab Clopidogrel Oral 75mg OD
Prevents blood
clot
Tab. Atorva Atorvastatin Oral 40mg OD
High
cholesterol
Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
Syp. Cremoffin
Sodium Picosulphate + Soft
Paraffin + Milk of Magnesia Oral
3.33mg + 1.25ml +
3.75ml HS Constipation
Tab ISMO
Isosorbide
Mononitrate
Oral 10mg BD Chest Pain
Tab Met-XL Metoprolol Succinate Oral 25mg OD
Chest Pain,
High BP
Tab Torvasan-F
Atorvastatin+Fenofibrat
e
Oral 10mg+160mg OD
High
Cholesterol
Tab Folvite Folic Acid Oral 5mg BD FASupplement
Vit B12
DAY-8
• Vitals:
• Advice: Continue same treatment.
Temperature
CNS: Conscious, OPA:
Tenderness
98°F
Pulse 74/min
Respiration 17/min
BP 120/80 mmHg
SPO2 98%
PLANNING: DAY-9
Brand Name Generic Name
Route of
Admin.
Dose Frequency Indication
Tab. Pantocid Pantoprazole IV 40mg BD
Treatment of
Acidity
Inj. Lasix Furosemide IV 40mg SOS
Oedema and
High BP
Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD
Prevents blood
clot
Tab. Clopitab Clopidogrel Oral 75mg OD
Prevents blood
clot
Tab. Atorva Atorvastatin Oral 40mg OD
High
cholesterol
Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
Syp. Cremoffin
Sodium Picosulphate + Soft
Paraffin + Milk of Magnesia Oral
3.33mg + 1.25ml +
3.75ml HS Constipation
Tab ISMO
Isosorbide
Mononitrate
Oral 10mg BD Chest Pain
Tab Met-XL Metoprolol Succinate Oral 25mg OD
Chest Pain,
High BP
Tab Torvasan-F
Atorvastatin+Fenofibrat
e
Oral 10mg+160mg OD
High
Cholesterol
Tab Folvite Folic Acid Oral 5mg BD FASupplement
Vit B12
DAY-9
• Vitals:
• Advice: Discharge
Temperature
CNS: Conscious, OPA:
Tenderness
97°F
Pulse 77/min
Respiration 19/min
BP 130/80 mmHg
SPO2 99%
DISCHARGE DETAILS
• Tab Ecosprin 150mg (0-1-0)
• Tab Clopitab 75mg (1-0-1)
• Tab Torvasan-F 10mg+160mg (0-0-1)
• Tab Pantocid 40mg (1-0-1)
• Tab Folvite 5mg (1-0-1)
TREATMENT
• Pantocid: PPI: Inhibits gastric acid production. Relieves acidity.
• Emeset: Serotonin Antagonist: Prevents N&V.
• Clexone: Anticoagulant: Binds to clotting factor Xa. Prevents Clotting.
• Lasix: Diuretic: Reduces BP and Oedema.
• Ecosprin: COX Inhibitor: Inhibits COX-1. Anti-platelet effect.
• Clopitab: Anticoagulant: Inhibits adenosine diphosphatase receptor. Inhibits platelet activation
and aggregation.
• Atorvastatin: Statin: Inhibits HMG Co-A. Reduces serum LDL-C Conc.
• Alprax: Benzodiazepines: Binds to GABA gives anti anxiolytic Effect.
• Cremoffin: Laxative: Softens Faecal Matter.
• ISMO: Nitrates: Vasodilator and Antianginal action.
• Met-XL: Metoprolol succinate: Beta-1 blocker. Reduces BP.
• Torvasan-F: Atorvastatin+Fenofibrate: Statin reduces blood cholesterol and Fibrate helps in
elimination of TGL and thus reduction of lipids.
• Folvite: Folic Acid Supplement.
• Mbson-Sl: Methlycobalamin Supplement.
PATIENT COUNSELLING
• About the disease:
- Myocardial Infarction, commonly known as heart
attack occurs when the blood supply to the heart
decreases or stops, causing damage to the heart
tissue.
PATIENT COUNSELLING
• About lifestyle modifications:
- Take Soft diet for some days.
- Avoid high calorie intake.
- Practice mild exercises.
- Reduce smoking day by day and Stop eventually.
- Avoid activities that lead to exertion like weight lifting.
- Monitor blood pressure and lipid levels at monthly
intervals.
PATIENT COUNSELLING
• About the medications:
- Ecosprin: Side effects may or may not occur including GI
irritation, N&V(Nausea & Vomiting), Dyspepsia, Ulceration etc.
- Pantocid: Taken after meal. Side effects may or may not occur
including N&V, Headache etc.
- Clopitab: Maybe taken with or without food, but at fixed time.
Dose and duration strictly taken as prescribed. Increases
Bleeding tendency.
- Torvasan-F: Taken with food. Side effects may or may not
occur inlcluding Nausea, Headache, Constipation, Increased
Glucose Levels etc.
- Folvite: Has very few side effects.

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Case on myocardial infarction

  • 1. CASE PRESENTATION ON ‘ACUTE MYOCARDIAL INFARCTION’ Presented by: Netal Patel (09) Pharm D. 2nd Year
  • 2. ABOUT THE DISEASE • Myocardial infarction (MI) is a medical term for heart attack. It is the necrosis (irreversible death) of the heart muscle secondary to prolonged lack of oxygen supply that is Ischemia.
  • 3. SUBJECTIVE EVIDENCE • Name: Mr. ABC • Age: 65Yrs • Gender: Male • Patient IP Number: 18013567 • Department: Male Medicine Ward • Unit: III
  • 4. SUBJECTIVE EVIDENCE Reasons for admission: C/o • Chest Pain at midnight relieved by 1:00 am • Chest Burning at the time of admission • Discomfort and Restlessness
  • 5. HISTORY • Past Medical History: No History • Social History: Smoking since very long time • Family History: NA • Allergies: NA
  • 6. OBJECTIVE EVIDENCE • General: Average Built • CVS: S1S2 heard • RS: AeBe clear • CNS: Conscious, Oriented • P/A: Soft,Non tender • BP: 130/70mmHg • P: 105 B/min • Temp: 98°F
  • 7. LAB INVESTIGATIONS Component Patient Results Standard Range Units Hb 14.1 (11.5-18) gm% WBC 10.22 (4-11x10^3) ) Nos Neutrophils 78 (40-70) % Eosinophils 1 (1-6) % Lymphocytes 18 (20-40) % Monocytes 3 (2-10) % Basophils 0 (0-1) % RBC 3.84 M(4.5-6x10^12) F(3.8-5.8x10^12) Nos Platelets 2.95 (1.5-4x10^5) Nos PCV 43.4 (40-54) % MCV 113.1 (78-100) fL MCH 36.7 (27-31) pg ‣ COMPLETE BLOOD COUNT (HEMATOLOGY) (DAY 1- 25/07/18)
  • 8. LAB INVESTIGATIONS ‣ LIVER FUNCTION TESTS (DAY 1- 25/07/18) Component Patient Results Standard Range ALT/SGPT 18 Upto 40IU/L ‣ SERUM ELECTROLYTE TESTS (DAY 1- 25/07/18) Component Patient Results Standard Range Na+ 130 130-145mEq/L K+ 4.2 3-5mEq/L Cl- 98 98-106mEq/L Ser. Creatinine 0.8 Unto 1.5 mg/dL
  • 9. LAB INVESTIGATIONS ‣ TROPONIN DETECTION (DAY 1- 25/07/18) Component Result S. Troponin-I Weak Positive ‣ 2-D ECHO (DAY 1- 25/07/18) Conclusion: Ischaemic heart disease involving LAD territory. ‣ LIPID PROFILE (DAY 1- 25/07/18) Component Patient Results Standard Range S. Cholesterol 225 <200 mg/dl S. LDL 158.1 <100 mg/dl
  • 11. JUSTIFICATION • A 65 year old male patient was admitted to Medicine ward-3 with complaints of chest pain at night, heartburn, discomfort and restlessness. • Based on lab report patient had symptoms of Heart attack ie. radiating chest pain for more than 15 minutes. The CBC was abnormal, Troponin I weakly positive and 2D Echo suggested that the patient had CAD with LAD blockage.
  • 13. GOALS OF TREATMENT • Relieve or reduce restlessness and heartburn. • Improve patient’s quality of life. • Prevent or minimise hospitalisations for further chances of Heart Failure. • Reduce future complications associated with cardiovascular system. • Slow the progression of disease and prolong survival.
  • 14. PLANNING: DAY-1(ICU) Brand Name Generic Name Route of Admin. Dose Frequency Indication Inj. Pantocid Pantoprazole IV 40mg BD Treatment of Acidity Inj. Emeset Ondansetron IV 4mg TDS Nausea, Vomitting Inj. Clexone Enoxaparin SC 40mg BD Prevents Thrombosis Inj. Lasix Furosemide IV 40mg SOS Oedema and High BP Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD Prevents blood clot Tab. Clopitab Clopidogrel Oral 75mg OD Prevents blood clot Tab. Atorva Atorvastatin Oral 40mg OD High cholesterol Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety
  • 15. DAY-1(ICU) • Fresh complaint: Chest pain • Tablet prescribed for Complaint: ‣ Add Tab. ISMO 10mg BD and Tab. Met-XL 25mg • Vitals: • Advice: ‣ CBC ‣ Creatinine ‣ Na+, K+ ‣ SGPT ‣ 2-D Echo ‣ Troponin-I Temperature CNS: Conscious, OPA: Tenderness 98°F Pulse 90/min Respiration 24/min BP 120/80 mmHg SPO2 99% ‣ Lipid Profile
  • 16. PLANNING: DAY-2(ICU) Brand Name Generic Name Route of Admin. Dose Frequency Indication Inj. Pantocid Pantoprazole IV 40mg BD Treatment of Acidity Inj. Emeset Ondansetron IV 4mg TDS Nausea, Vomitting Inj. Clexone Enoxaparin SC 40mg BD Prevents Thrombosis Inj. Lasix Furosemide IV 40mg SOS Oedema and High BP Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD Prevents blood clot Tab. Clopitab Clopidogrel Oral 75mg OD Prevents blood clot Tab. Atorva Atorvastatin Oral 40mg OD High cholesterol Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety Syp. Cremoffin Sodium Picosulphate + Soft Paraffin + Milk of Magnesia Oral 3.33mg + 1.25ml + 3.75ml HS Constipation Tab ISMO Isosorbide Oral 10mg BD Chest Pain
  • 17. DAY-2(ICU) • Vitals: • Advice: ‣ 2-D Echo ‣ Daily ECG ‣ Continue same treatment Temperature CNS: Conscious, OPA: Tenderness 97°F Pulse 70/min Respiration 16/min BP 110/70 mmHg ‣ THYROID FUNCTION TEST (DAY 2- 26/07/18) Component Result Standard Range TSH (2nd Gen) 0.84 0.3-5.0 uIU/mL ‣ Change Pantocid toTablet ‣ Stop Emeset
  • 18. PLANNING: DAY-3,4,5(ICU) Brand Name Generic Name Route of Admin. Dose Frequency Indication Tab. Pantocid Pantoprazole Oral 40mg BD Treatment of Acidity Inj. Clexone Enoxaparin SC 40mg BD Prevents Thrombosis Inj. Lasix Furosemide IV 40mg SOS Oedema and High BP Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD Prevents blood clot Tab. Clopitab Clopidogrel Oral 75mg OD Prevents blood clot Tab. Atorva Atorvastatin Oral 40mg OD High cholesterol Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety Syp. Cremoffin Sodium Picosulphate + Soft Paraffin + Milk of Magnesia Oral 3.33mg + 1.25ml + 3.75ml HS Constipation Tab ISMO Isosorbide Mononitrate Oral 10mg BD Chest Pain Tab Met-XL Metoprolol Succinate Oral 25mg OD Chest Pain,
  • 19. DAY-3,4,5(ICU) • Vitals: • Advice: ‣ Daily ECG ‣ Continue same treatment ‣ Shift the patient to General Medicine Ward ‣ Add Tab. Torvasan-F ‣ Stop Clexone Temperature CNS: Conscious, OPA: Tenderness 98°F Pulse 96/min Respiration 24/min BP 120/80 mmHg SPO2 99%
  • 20. PLANNING: DAY-6,7 Brand Name Generic Name Route of Admin. Dose Frequency Indication Tab. Pantocid Pantoprazole Oral 40mg BD Treatment of Acidity Inj. Lasix Furosemide IV 40mg SOS Oedema and High BP Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD Prevents blood clot Tab. Clopitab Clopidogrel Oral 75mg OD Prevents blood clot Tab. Atorva Atorvastatin Oral 40mg OD High cholesterol Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety Syp. Cremoffin Sodium Picosulphate + Soft Paraffin + Milk of Magnesia Oral 3.33mg + 1.25ml + 3.75ml HS Constipation Tab ISMO Isosorbide Mononitrate Oral 10mg BD Chest Pain Tab Met-XL Metoprolol Succinate Oral 25mg OD Chest Pain, High BP Tab Torvasan-F Atorvastatin+Fenofibrat Oral 10mg+160mg OD High
  • 21. DAY-6,7 • Vitals: • Advice: ‣ Daily ECG ‣ Add Tab Folvite 5mg , Mbson-SL ‣ CBC, Liver FT, Electrolytes Temperature CNS: Conscious, OPA: Tenderness 98°F Pulse 78/min Respiration 18/min BP 130/80 mmHg SPO2 97%
  • 22. Component Patient Results Standard Range Units Hb 11.6 (11.5-18) gm% WBC 6320 (4-11x10^3) ) Nos Neutrophils 63 (40-70) % Eosinophils 1 (1-6) % Lymphocytes 32 (20-40) % Monocytes 4 (2-10) % Basophils 0 (0-1) % RBC 3.14 M(4.5-6x10^12) F(3.8-5.8x10^12) Nos Platelets 2.95 (1.5-4x10^5) Nos PCV 35.5 (40-54) % MCV 113.0 (78-100) fL MCH 36.9 (27-31) pg ‣ COMPLETE BLOOD COUNT (HEMATOLOGY) (DAY 7- 31/07/18)
  • 23. ‣ LIVER FUNCTION TESTS (DAY 7- 31/07/18) Component Patient Results Standard Range ALT/SGPT 23 Upto 40IU/L ‣ SERUM ELECTROLYTE TESTS (DAY 7- 25/07/18) Component Patient Results Standard Range Na+ 131 130-145mEq/L K+ 4.3 3-5mEq/L Cl- 99 98-106mEq/L Ser. Creatinine 0.9 Unto 1.5 mg/dL
  • 24. PLANNING: DAY-8 Brand Name Generic Name Route of Admin. Dose Frequency Indication Tab. Pantocid Pantoprazole IV 40mg BD Treatment of Acidity Inj. Lasix Furosemide IV 40mg SOS Oedema and High BP Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD Prevents blood clot Tab. Clopitab Clopidogrel Oral 75mg OD Prevents blood clot Tab. Atorva Atorvastatin Oral 40mg OD High cholesterol Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety Syp. Cremoffin Sodium Picosulphate + Soft Paraffin + Milk of Magnesia Oral 3.33mg + 1.25ml + 3.75ml HS Constipation Tab ISMO Isosorbide Mononitrate Oral 10mg BD Chest Pain Tab Met-XL Metoprolol Succinate Oral 25mg OD Chest Pain, High BP Tab Torvasan-F Atorvastatin+Fenofibrat e Oral 10mg+160mg OD High Cholesterol Tab Folvite Folic Acid Oral 5mg BD FASupplement Vit B12
  • 25. DAY-8 • Vitals: • Advice: Continue same treatment. Temperature CNS: Conscious, OPA: Tenderness 98°F Pulse 74/min Respiration 17/min BP 120/80 mmHg SPO2 98%
  • 26. PLANNING: DAY-9 Brand Name Generic Name Route of Admin. Dose Frequency Indication Tab. Pantocid Pantoprazole IV 40mg BD Treatment of Acidity Inj. Lasix Furosemide IV 40mg SOS Oedema and High BP Tab. Ecosprin Acetylsalicylic acid Oral 150mg OD Prevents blood clot Tab. Clopitab Clopidogrel Oral 75mg OD Prevents blood clot Tab. Atorva Atorvastatin Oral 40mg OD High cholesterol Tab. Alprax Alprazolam Oral 0.25mg HS Anxiety Syp. Cremoffin Sodium Picosulphate + Soft Paraffin + Milk of Magnesia Oral 3.33mg + 1.25ml + 3.75ml HS Constipation Tab ISMO Isosorbide Mononitrate Oral 10mg BD Chest Pain Tab Met-XL Metoprolol Succinate Oral 25mg OD Chest Pain, High BP Tab Torvasan-F Atorvastatin+Fenofibrat e Oral 10mg+160mg OD High Cholesterol Tab Folvite Folic Acid Oral 5mg BD FASupplement Vit B12
  • 27. DAY-9 • Vitals: • Advice: Discharge Temperature CNS: Conscious, OPA: Tenderness 97°F Pulse 77/min Respiration 19/min BP 130/80 mmHg SPO2 99%
  • 28. DISCHARGE DETAILS • Tab Ecosprin 150mg (0-1-0) • Tab Clopitab 75mg (1-0-1) • Tab Torvasan-F 10mg+160mg (0-0-1) • Tab Pantocid 40mg (1-0-1) • Tab Folvite 5mg (1-0-1)
  • 29. TREATMENT • Pantocid: PPI: Inhibits gastric acid production. Relieves acidity. • Emeset: Serotonin Antagonist: Prevents N&V. • Clexone: Anticoagulant: Binds to clotting factor Xa. Prevents Clotting. • Lasix: Diuretic: Reduces BP and Oedema. • Ecosprin: COX Inhibitor: Inhibits COX-1. Anti-platelet effect. • Clopitab: Anticoagulant: Inhibits adenosine diphosphatase receptor. Inhibits platelet activation and aggregation. • Atorvastatin: Statin: Inhibits HMG Co-A. Reduces serum LDL-C Conc. • Alprax: Benzodiazepines: Binds to GABA gives anti anxiolytic Effect. • Cremoffin: Laxative: Softens Faecal Matter. • ISMO: Nitrates: Vasodilator and Antianginal action. • Met-XL: Metoprolol succinate: Beta-1 blocker. Reduces BP. • Torvasan-F: Atorvastatin+Fenofibrate: Statin reduces blood cholesterol and Fibrate helps in elimination of TGL and thus reduction of lipids. • Folvite: Folic Acid Supplement. • Mbson-Sl: Methlycobalamin Supplement.
  • 30. PATIENT COUNSELLING • About the disease: - Myocardial Infarction, commonly known as heart attack occurs when the blood supply to the heart decreases or stops, causing damage to the heart tissue.
  • 31. PATIENT COUNSELLING • About lifestyle modifications: - Take Soft diet for some days. - Avoid high calorie intake. - Practice mild exercises. - Reduce smoking day by day and Stop eventually. - Avoid activities that lead to exertion like weight lifting. - Monitor blood pressure and lipid levels at monthly intervals.
  • 32. PATIENT COUNSELLING • About the medications: - Ecosprin: Side effects may or may not occur including GI irritation, N&V(Nausea & Vomiting), Dyspepsia, Ulceration etc. - Pantocid: Taken after meal. Side effects may or may not occur including N&V, Headache etc. - Clopitab: Maybe taken with or without food, but at fixed time. Dose and duration strictly taken as prescribed. Increases Bleeding tendency. - Torvasan-F: Taken with food. Side effects may or may not occur inlcluding Nausea, Headache, Constipation, Increased Glucose Levels etc. - Folvite: Has very few side effects.