It is a case study on CAD with LV failure diagnosed in a male patient aged 70 years. The powerpoint includes SOAP notes

1. CASE STUDY ON CORONARY
ARTERY DISEASE
WITH
LEFT VENTRICULAR FAILURE
PREPARED BY:
SUMAIYA SALEEM
III PHARM D

2. CORONARY ARTERY DISEASE
CAUSES
• It is a condition in which the coronary artery gets plaque
in the inner walls thus causing rigidity and narrowing of
artery.
• This restricts blood flow to heart muscle thus causing
hypoxia.
- Smoking
- High blood pressure
- High cholesterol
- Diabetes
- Sedentary life style.
- High stress
- Unhealthy diet

3. SYMPTOMS
DIAGNOSIS
- Chest pain
- Shortness of breadth
- Heart attack
- Pain radiating to limbs and neck
- Indigestion
- Nausea
- Sweating
- Electrocardiogram (ECG)
- CT scan
- Echocardiogram
- Stress test

5. LEFT VENTRICULAR FAILURE
CAUSES
• Heart failure is a state in which the heart cannot provide
sufficient cardiac output to satisfy the needs of the body.
• Left ventricular failure occurs when the ability of
ventricles to pump blood to the body decreases which
leads to left ventricular remodeling.
- Alcohol
- Heart attack
- Hypertension
- Hypothyroidism
- Leaking or narrow heart valves
- Volume overload

6. SYMPTOMS
DIAGNOSIS
- Echocardiogram
- Electrocardiogram
- Treadmill test
- Cough
- Shortness of breadth
- Irregular heart rate
- Weight gain
- Fatigue
- Weakness
- Decreased urine output

8. SUBJECTIVE DATA
PATIENT PROFILE
• NAME : XXX
• AGE : 70 yrs
• GENDER : Male
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9. CHIEF COMPLAINT
• Complaint of shortness of breadth on exertion.
• Chest pain since 1 day.
• Complaint of pedal edema since 1 week.
• Complaint of fever since 2 days.
PAST HISTORY
• No similar complaints in the past were observed.
• Diabetes mellitus.
• Hypertension.
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10. PERSONAL HISTORY
• DIET : Mixed diet
• SLEEP : Normal
• APPETITE : Normal
• BOWELAND
BLADDER HABITS : Regular and Normal
•ALCOHOLIC / SMOKER : Non- alcoholic, Not a
smoker
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11. GENERAL EXAMINATION
• Patient is conscious and coherent.
• Moderately built and nourished.
• Not having pallor, icterus, clubbing, sinosis and
lymphadenopathy.
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12. S.
NO.
LABORATORY
INVESTIGATIONS
PATIENTS
VALUES
NORMAL
VALUES
1. Serum creatinine 1,2 mg/dl 0.6- 1.2 mg/dl
2. Serum alkaline
phosphatase
129 IU/L 44- 147 IU/L
3. Blood urea 125 mg/dl 120- 140 mg/dl
4. Blood sugar 118 mg/dl 100- 140 mg/dl
5. Serum direct bilirubin 0.4 g/dl <0.3 mg/dl
6. Serum indirect bilirubin 0.7 mg/dl <0.7 mg/dl
7. Serum total bilirubin 1.1 mg/dl 0.3- 1 mg/dl
8. Serology HBsAg Negative Negative
9. Serology HIV Negative Negative
OBJECTIVE DATA
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13. 13
2D ECHO
Global hypokinesia of left ventricle.
Moderate LV dysfunction.
Dilated right atrium, right ventricle and left atrium.
Severe TR/PAH
Severe MR
No clot
Ejection fraction: 28%

14. DIAGNOSIS
14
CORONARY ARTERY DISEASE
with LEFT VENTRICULAR FAILURE

15. MEDICATION CHART
DRUG INDICATION DOSE ROA FREQUENCY
Tab. Aspirin NSAID 150 mg oral OD
Tab. Clopitab Anti platelet 75 mg oral OD
Tab. Atorvastatin HMG CoA
reductase
inhibitors
20 mg oral OD
Tab. Furosemide Loop diuretic 40 mg oral BD
Tab.
Spiranolactone
Potassium
sparing diuretic
25 mg oral BD
Tab. Metoprolol β blocker 25 mg oral OD
Tab. Cefixime Antibiotic 200 mg oral BD
Tab. Metformin Anti-diabetic 500 mg oral BD

16. 1. Aspirin + Clopidogrel
Combination of these two may cause unusual bleeding,
severe abdominal pain, weakness, and the appearance of
black, tarry stools.
2. Atorvastatin + Clopidogrel
Atorvastatin reduces the blood levels and effects of
Clopidogrel.
3. Furosemide + Metoprolol / Spiranolactone + Furosemide
/ Metaprolal + Spiranolactone
Administering the drugs together may cause in severe
decrease in the blood pressure and slow the heart rate. It
causes dizziness and weakness, irregular heart beat etc.
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DRUG INTERACTIONS

17. 4. Furosemide + Cefixime
Cephalosporin antibiotics like Cefixime can occasionally
cause kidney problems, and using it with furosemide may
increase that risk.
5. Furosemide + Metformin
Using furosemide together with metformin may increase the
effects of metformin.

18. PROGRESS
DAY 1:
• Patient conscious and coherent
• BP : 130/ 100 mm of Hg
• PR : 88 beats/ min
• Temp : Afebrile
• Medications : Aspirin, Clopitab, Atorvastatin, Furosemide,
Spiranolactone, Metoprolol, Cefixime, Metformin
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19. • Patient conscious and coherent
• BP : 130/ 70 mm of Hg
• PR : 84 beats/ min
• Temp : Afebrile
• Medications: C.S.T
DAY 3:
19
DAY 2:
• Patient conscious and coherent
• BP : 130/ 80 mm of Hg
• PR : 126 beats/ min
• Temp : Afebrile
• Medications: C.S.T

20. DAY 4:
• Patient conscious and coherent
• BP : 120/ 70 mm of Hg
• PR : 86 beats/ min
• Temp : Afebrile
• Medications: C.S.T

21. PATIENT COUNSELLING
ABOUT THE DISEASE:
• Coronary artery disease is a condition in which the coronary
artery gets plaque in the inner walls. This restricts the flow of
blood to heart muscle thus causing hypoxia.
• Heart failure is a state n which the heart cannot provide
sufficient cardiac output to satisfy the needs of the body.
• Left heart failure occurs when the ability of ventricles to
pump blood to the body decreases which leads to left
ventricular remodeling.
21

22. ABOUT THE MEDICATION:
1. Tablet Aspirin: It is a Non- Steroidal Anti Inflammatory
Drug used to reduce fever and relive mild to moderate
pains. Low doses are given to prevent blood clots to
reduce the risk of stokes and heart attacks.
Side effects
- Excess acid secretion
- Nausea
- Heart burn
- Irritation of stomach
- Stomach cramps
- Severe dizziness
Pharmacokinetics
-Half life: approx. 15 min
-Bioavailability: 40 %
-Onset of action: 5- 30 min
-Duration of action: 3- 6 hrs
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23. 2. Tablet Clopitab: It is an anti platelet drug which is used
to prevent the clot formation in the blood vessels. It
works by preventing the platelets from sticking together
to each other. This decreases the risk of stoke.
Side effects
- Easy bleeding
- Diarrhoea
- Constipation
- Upset stomach
- Redness of skin
- Difficulty in breathing
- Blood in urine and stools.
Pharmacokinetics
- Half life: 30 min
- Bioavailability: 99 %
- Onset of action: 2 hrs
- Duration of action: 12 hrs
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24. 3. Tablet Atorvastatin: It is used to reduce the levels of
cholesterol and triglycerides in blood. Due to which it
avoids the obstruction of blood vessels due to
accumulation of cholesterol in them.
Side effects
- Cold
- Gas
- Heart burn
- Diarrhoea
- Upper stomach ache
- Joint pain
- Weakness
- Confusion
- Loss of appetite.
Pharmacokinetics
- Half life:14 hrs
- Bioavailability: 14 %
- Onset of action: 3- 5 days
- Duration of action: 2- 4 weeks
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25. 4. Tablet Furosemide: It is a loop diuretic that prevents the
body from absorbing too much salt and allows the salt to
pass through urine. It is used to treat fluid retention in
people with heart failure, liver damage, kidney disorders,
hypertension.
Side effects:
- Rashes
- Dizziness
- Diarrhoea
- Mild itching
- Stomach pain
- Constipation etc.
Pharmacokinetics
- Half life: 2 hrs
- Bioavailability: 50- 70 %
- Onset of action: 5 min
- Duration of action: 2 hrs
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26. 5. Tablet Spiranolactone: It is a potassium sparing diuretic.
It helps in the removal of excess fluid from the body. It is
used in congestive heart failure, nephrotic syndrome,
abdominal distension, hypertension etc.
Side effects:
- Nausea
- Dizziness
- Vomiting
- Leg cramps
- Confusion
- Drowsiness
- Increased creatinine level.
Pharmacokinetics
- Half life: 1.3 hrs
- Bioavailability: 50- 70 %
- Onset of action: 5 min
- Duration of action: 2 hrs
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27. 6. Tablet Metoprolol: It belongs to the class of drugs called
Beta blockers. It blocks the beta- adrenergic receptors
therefore reducing the blood pressure and heart rate. It is
used in treatment of angina, CHF, Hyperthyroidism.
Side effects:
- Low blood pressure
- Diarrhoea
- Constipation
- Depression
- Memory loss
- Fever
- Nausea
- Abdominal cramps
- Shortness of breadth
Pharmacokinetics
- Half life: 3- 4 hrs
- Bioavailability: 50 %
- Onset of action: 1 hr
- Duration of action: 3- 6 hrs
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7. Tab. Cefixime: It is used to treat certain infections caused by
bacteria such as bronchitis, gonorrhoea and infections of the
ears, throat, tonsils, and urinary tract. It belongs to class of
medications called cephalosporin antibiotics
Side effects:
- Stomach pain
- Gas
- Dizziness
- Diarrhoea
- Headache
- Nausea and vomiting
- Trouble breathing
- Rashes
Pharmacokinetics
- Half life: 3- 4 hours
- Bioavailability: 40- 50 %
- Duration of action: 3- 4 hours

29. Pharmacokinetics
- Half life: 6 hrs
- Bioavailability: 50-60 %
- Onset of action: 1- 3 hrs
- Duration of action: 4- 8 hrs
8. Tablet Metformin: It is an anti- diabetic drug used for
suppression of gluconeogenesis & improvement of
glucose uptake & insulin sensitivity.
Side effects:
- Heart burn
- Stomach pain
- Bloating
- Weight loss
- Hypoglycemia

30. LIFE STYLE MODIFICATIONS
1. Decrease the intake of salt.
2. Avoid alcohol and Smoking.
3. Exercise regularly.
4. Take in fibre rich food.
5. Decrease stress and handle
situations calmly.
6. Eat foods with low oils
and cholesterols.
7. Administer the medications
prescribed regularly.
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31. REFERENCE
• www.mayoclinic.org
• www.webmd.com
• www.healthline.com
• www.drugs.com

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