Pharmacotherapeutics - I: Case Study On Anterior Wall Myocardial Infarction

PHARMACOTHERAPEUTICS - I
CASE STUDY ON ANTERIOR

WALL MYOCARDIAL
INFARCTION
SUBALAKSHMI
II-PHARM.D
A 60 YEAR OLD FEMALE PATIENT WAS
ADMITTED TO THE HOSPITAL
CHIEF COMPLAINTS
Giddiness since 2 days
Breathlessness since 2 days
vomiting since 2 days
Fever for past 3 days with chills
Chest pain since 2 days
ON EXAMINATION :
Parameters Diagnostic Patient Inference
values values
Temperature 98.6 F 100 F Increased
Pulse rate 69-100/min 80/min Normal
Respiratory rate 12-20/min 30/min Increased
Blood pressure 120/80 mm/hg 120/80 mm/hg Increased
CVS S1 S2 Audible
Murmured
RS NAD
CNS NAD
GU & GI P/A Soft

PAST HISTORY :
PAST MEDICAL HISTORY :

Not a known case of hypertension and
diabetes mellitus.
PAST MEDICATION HISTORY :
Nil
ECG :
LAB INVESTIGATIONS :
Parameters Diagnostic Patient Inference

values values
Haemoglobin 12-17 g/dl 12.1 g/dl Normal
RBC 3.8-4.8 mill/cc 3.9 mill/cc Normal
MCV 76-96 fl 86.9 fl Normal
MCH 27-32 pg 30.4 pg Normal
MCHC 31-35 35 Normal
PLT 1.5-4 3 lakhs Normal

lakhs/cu.mm
Serum 0.6-1.3 mg/dl 0.56 mg/dl Normal
creatinine
CARDIAC MARKERS :
Parameters Diagnostic Patient values Inference

values
CPK 21-23 U/L 19 U/L Decreased
CPK-MB 0-6 U/L 7 U/L Increased
BNP 0.0-100 pg/ml 0.5 pg/ml Normal

DRUG CHART :
Generic Dose Route Frequency Indication

name
Inj. Heparin 2500 USP IV 1-0-1 Anti-
units/ml coagulant
T. Aspirin 50 mg P/O 1-0-1 Anti-
inflammator
y
T. 75 mg P/O 1-0-1 Anti-platelet
Clopidrogel
T.Atorvastat 40 mg P/O 1-0-1 Anti-
in hyperlipide
mic
SOAP NOTES :
SUBJECTIVE :
A 60 year old female patient was
admitted to the hospital with the chief
complaints of
Giddiness since 2 days
Breathlessness since 2 days
Chest pain since 2 days
Vomiting since 2 days of 2
episodes
Fever since 3 days with chills
OBJECTIVE
On physical examination and laboratorial value
interpretations, the patient was found to be febrile
and non-anemic.
The patient had a Blood pressure of 120/80, pulse
rate of 80/min, respiratory rate of 30/min with a slight
high temperature of 100 F.
The patient’s vitals were abnormal.
The blood examination revealed a decrease in
CPK (19) and others were quiet normal
In system examinations the patients CVS was
found to be abnormal and no abnormalities were
detected in other systems
LAB INVESTIGATIONS
S.NO INVESTIGATION SUBJECT VALUE NORMAL VALUE INFERENCE

PARAMETERS
1. HB 12.5 g/dl 12 – 17 g/dl Within limits

2. TC 5000 cumm 4000 - 11000 cumm Within limits
3. DC
P 54 % 40 - 80 % Within limits
L 35 % 20 - 40 % Within limits
E 4.5 % 1-6% Within limits
4. MCV 86.9 fl 76 - 96 fl Within limits

5. MCH 30.4 pg 27 - 32 pg Within limits
6. MCHC 33.2 g/dl 31 - 35 g/dl Within limits
7. PLT 3 lakh/cumm 1.5 - 4 lakh/cumm Within limits
8. ESR 5.8 mm/hr 5 - 20 mm/hr Within limits

9. RBC 3.9 mill/cc 3.8 - 4.8 mill/cc Within limits
10. CPK 19 U/L 21 - 23 U/L Decreased
11. CPK - MB 7 U/L 0 - 6 U/L Increased
ASSESSMENT
The patient was assessed for the following condition
ANTERIOR WALL MYOCARDIAL INFARCTION
Anterior wall myocardial infarction is
commonly known as heart attack, which occurs when blood
flow decreases or stops to a part of a heart causing damage
to heart muscle.
The signs and symptoms of the disease is chest
pain, discomfort etc..
The complications of the disease are severe left
ventricular dysfunction, cardiogenic shock, heart failure.
PLAN : TREATMENT CHART
S.NO GENERIC NAME DOSE ROUTE FREQUENCY INDICATIONS
1. Inj. Heparin 2500 USP IV 1-0-1 Anti-coagulant

units/ml
2. T. Acetyl salicylic acid 50 mg P/O 1-0-1 Anti -

inflammatory
3. T. Clopidrogel 75 mg P/O 1-0-1 Anti-platelet
4. T. Atorvastatin 40 mg P/O 1-0-1 Anti-

hyperlipidemic
INTERVENTION
Concurrent use of Aspirin and Clopidogrel

results in increased risk of bleeding
Concurrent use of Heparin and Aspirin also
results in increased risk of bleeding
Concurrent use of Clopidogrel and
Atorvastatin result in decreased formation of
Clopidogrel active metabolite resulting in high on
treatment platelet reactivity
DISCUSSION
A 60 year old female was admitted in the hospital with the
chief complaints of giddiness, breathlessness, chest pain. On physical
examination and laboratorial value interpretations the patient was
found to be febrile and non-anaemic.
The female had a Blood pressure of 120/80 mm/hg, pulse rate of
80/min, respiratory rate of 30/min with a slight high temperature of
100 F.
The patient’s vitals were abnormal.
The blood examination revealed a increase in cardiac markers .
In system examinations the patient’s CVS was found to be
abnormal and no abnormalities were detected in other systems.
The patient was prescribed with anticoagulant such as heparin,
anti- inflammatory such as aspirin, anti platelet such as clopidrogel
and anti hyperlipidemic such as atorvastatin.
The patient was counselled with respect to disease, drugs,
lifestyle modifications.
PATIENT COUNSELLING
REGARDING DISEASE :
Anterior wall myocardial infarction is
commonly known as heart attack, which occurs
when blood flow decreases or stops to a part of a
heart causing damage to heart muscle.
The signs and symptoms of the
disease is chest pain, discomfort etc..
The complications of the disease are
severe left ventricular dysfunction, cardiogenic
shock, heart failure.
REGARDING DRUGS
 Aspirin tablet is administered after food twice a day. Common side

effects include nausea, vomiting, stomach pain.
 Atorvastatin tablet is also administered after food twice a day.
Common side effects are diarrhoea, insomnia, UTI.
 Clopidogrel tablet is given through oral route twice a day. Common
side effects are nausea, vomiting, sweating.
The above given drugs may cause nausea,
vomiting, head ache, pruritis, dizziness, vertigo, gastrointestinal
disturbances etc..
If it persists consult your doctor.
Do not take a double doses to make up for an
forgotten dose.
If you forget to take it as soon as you remember
and then continue to take next dose at right time.
REGARDING LIFESTYLE
MODIFICATION
 Diet that’s low in saturated fat and cholesterol and

that includes omega-3 fatty acids, fruits, vegetables,
soluble fibre, and whole grains only should be
consumed.
 Engage in moderate-intensity aerobic activity, such as
walking, jogging, or cycling, at least 30 to 60 minutes a
day on most preferably all days of the week.
 Weight should be managed and controlled.
 Stop smoking and avoid secondhand smoking.
 Take one nitroglycerin dose sublingually for chest

pain.
 If symptoms of MI develop, the patient should be
transported to the hospital by ambulance.
 Family members should be familiar with the
cardiopulmonary resuscitation and using an
automated external defibrillator.
 Cessation of smoking and alcohol is must.
THANK YOU

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PHARMACOTHERAPEUTICS - I

CASE STUDY ON ANTERIOR

Pulse rate 69-100/min 80/min Normal

Respiratory rate 12-20/min 30/min Increased

Blood pressure 120/80 mm/hg 120/80 mm/hg Increased

GU & GI P/A Soft

PAST MEDICAL HISTORY :

Parameters Diagnostic Patient Inference

RBC 3.8-4.8 mill/cc 3.9 mill/cc Normal

MCV 76-96 fl 86.9 fl Normal

MCH 27-32 pg 30.4 pg Normal

MCHC 31-35 35 Normal

PLT 1.5-4 3 lakhs Normal

Parameters Diagnostic Patient values Inference

CPK-MB 0-6 U/L 7 U/L Increased

BNP 0.0-100 pg/ml 0.5 pg/ml Normal

Generic Dose Route Frequency Indication

S.NO INVESTIGATION SUBJECT VALUE NORMAL VALUE INFERENCE

1. HB 12.5 g/dl 12 – 17 g/dl Within limits

4. MCV 86.9 fl 76 - 96 fl Within limits

8. ESR 5.8 mm/hr 5 - 20 mm/hr Within limits

S.NO GENERIC NAME DOSE ROUTE FREQUENCY INDICATIONS

1. Inj. Heparin 2500 USP IV 1-0-1 Anti-coagulant

2. T. Acetyl salicylic acid 50 mg P/O 1-0-1 Anti -

3. T. Clopidrogel 75 mg P/O 1-0-1 Anti-platelet

4. T. Atorvastatin 40 mg P/O 1-0-1 Anti-

Concurrent use of Aspirin and Clopidogrel

 Aspirin tablet is administered after food twice a day. Common side

 Diet that’s low in saturated fat and cholesterol and

 Stop smoking and avoid secondhand smoking.

 Take one nitroglycerin dose sublingually for chest

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