case study

1. CASE PRESENTATIONCASE PRESENTATION
BYBY
S.SANDHOSHINI MEENAS.SANDHOSHINI MEENA

2. A 62 years old male patient was admitted in hospital withA 62 years old male patient was admitted in hospital with
CHIEF COMPLAINTS :CHIEF COMPLAINTS :
Difficulty in breathing ,Difficulty in breathing ,
Frequent urination at night,Frequent urination at night,
Chest pain,Chest pain,
Chest tightness.Chest tightness.
HISTORY OF PRESENT ILLNESS:HISTORY OF PRESENT ILLNESS:
HeadacheHeadache,, Dyspnea, back pain, fatigue and weaknessDyspnea, back pain, fatigue and weakness

3. PAST MEDICAL HISTORY:PAST MEDICAL HISTORY:
-k/c/o systemic HTN for 10 years-k/c/o systemic HTN for 10 years
-Not a k/c/o asthma , tuberculosis, COPD-Not a k/c/o asthma , tuberculosis, COPD
PAST MEDICATION HISTORY:PAST MEDICATION HISTORY:
-- metoprolol-25mgmetoprolol-25mg
- captopril-50mg- captopril-50mg
PERSONAL HISTORY/SOCIAL HABITS:PERSONAL HISTORY/SOCIAL HABITS:
-- smokersmoker
- Takes mixed diet- Takes mixed diet
- MarriedMarried
- Not alcoholicNot alcoholic

4. PHYSICAL EXAMINATION:PHYSICAL EXAMINATION:
-Patient is conscious and oriented-Patient is conscious and oriented
-No pallor/icterus-No pallor/icterus
-Cyanosis is observed-Cyanosis is observed
-Afebrile-Afebrile
ON EXAMINATION:ON EXAMINATION:
PR:PR: 78 beats/min78 beats/min CVSCVS: S1&S2 sounds audible with: S1&S2 sounds audible with
RR:RR: 16 cycles/min mummer, S3 gallop16 cycles/min mummer, S3 gallop
TEMP:TEMP: 98.3°F98.3°F CNS:CNS: normalnormal
BPBP :180/90mmHg:180/90mmHg ↑↑ PP/A:/A: soft, normal bowel soundssoft, normal bowel sounds
areare audible.audible.

5. LAB INVESTIGATIONS:LAB INVESTIGATIONS:
PARAMETERSPARAMETERS OBSERVED VALUESOBSERVED VALUES NORAMLNORAML
VALUESVALUES
CBC:-CBC:-
HbHb 10g/dl10g/dl ↓↓ 14-18 g/dl14-18 g/dl
PlateletPlatelet 1,53,000 per1,53,000 per µ/lµ/l 1,50,000-4,00,0001,50,000-4,00,000
perper µ/lµ/l
ESRESR 12 mm/hr12 mm/hr 0-20mm/hr0-20mm/hr
EosinophilsEosinophils 3%3% 0-5%0-5%
BasophilsBasophils 1%1% 0-1%0-1%
MonocytesMonocytes 4%4% 0-7%0-7%

6. RENAL FUNCTIONRENAL FUNCTION
TESTTEST :-:-
BUNBUN 37mg/dl↑37mg/dl↑ 8-26mg/dl8-26mg/dl
CreatinineCreatinine 1.2mg/dl1.2mg/dl 0.5-1.2mg/dl0.5-1.2mg/dl
ELECTROLYTES:-ELECTROLYTES:-
Na+Na+ 151Meq/L151Meq/L ↑↑ 135-145Meq/L135-145Meq/L
K+K+ 2.3Meq/L2.3Meq/L ↓↓ 3.5-5.3Meq/L3.5-5.3Meq/L
Ca2+Ca2+ 114Meq/L114Meq/L ↑↑ 95-105Meq/L95-105Meq/L
HCo3-HCo3- 13Meq/L13Meq/L ↓↓ 22-29Meq/L22-29Meq/L

7. OTHER TESTS:-OTHER TESTS:-
- ECGECG
- X-RAYX-RAY
- ECHOECHO
IMPERSSION:-IMPERSSION:-
-ECG:-ECG: Conduction is delayedConduction is delayed
--X-RAY:X-RAY: Heart size is enlargedHeart size is enlarged
-ECHO:-ECHO: Reduced left ventricular function and vascularReduced left ventricular function and vascular
insufficiency.insufficiency.
DIAGNOSIS:-DIAGNOSIS:-
systemic HTN and heart failuresystemic HTN and heart failure

8. DRUG CHART:-DRUG CHART:-
SlSl DRUGDRUG DOSEDOSE RORO
AA
FREQFREQ DURATIONDURATION
1.1. T.digoxinT.digoxin 0.125mg0.125mg oraloral odod      
2.2. T.furosemideT.furosemide 80mg80mg oraloral bidbid    
3.3. T.Metoprolol succinateT.Metoprolol succinate 25mg25mg oraloral bidbid      
4.4. T.Vitamin D3T.Vitamin D3 15mcg15mcg oraloral bidbid      
5.5. T.telmisartanT.telmisartan 60mg60mg oraloral bidbid  
6.6. Folic AcidFolic Acid 400mcg400mcg oraloral odod      

9. SOAP NOTES:-SOAP NOTES:-
SUBJECTIVE:SUBJECTIVE: A 62 year old male patient was admittedA 62 year old male patient was admitted
in hospital with c/oin hospital with c/o Difficulty in breathing , AdditionalDifficulty in breathing , Additional
heart sounds, Frequent urination at night, Chest pain,heart sounds, Frequent urination at night, Chest pain,
Chest tightness.Chest tightness.
OBJECTIVE:OBJECTIVE: upon examinations ,it was noted that patient hasupon examinations ,it was noted that patient has
high BP(180/90 mmHg) ,low Hb level and increased bloodhigh BP(180/90 mmHg) ,low Hb level and increased blood
urea nitrogen.urea nitrogen.
ASSESSMENT:ASSESSMENT: ECG, X-RAY, ECHO are taken for furtherECG, X-RAY, ECHO are taken for further
investigations and it shows that the patient has heart failure.investigations and it shows that the patient has heart failure.
PLAN OF TREATMENT:PLAN OF TREATMENT: T. digoxin is given to increase theT. digoxin is given to increase the
contractility. T. furosemide is given to treat HTN and tocontractility. T. furosemide is given to treat HTN and to
prevent from edema. T.metoprolol succinate is given alongprevent from edema. T.metoprolol succinate is given along
with digoxin for standard HF therapies.with digoxin for standard HF therapies.

10. PATIENT COUNSELLINGPATIENT COUNSELLING
 Daily weight monitoring.Daily weight monitoring.
 Fluid management (sodium restriction).Fluid management (sodium restriction).
 Avoid smoking.Avoid smoking.
 Take vitamin D nutritional supplement such as orange juice,Take vitamin D nutritional supplement such as orange juice,
Fatty fish like Tuna etc.Fatty fish like Tuna etc.

11. THANK YOUTHANK YOU