Post on 06-Jan-2016
description
PRESENTED BY-Dhaivat Joshi
(FINAL YEAR B.PHARMACY)
Hari Om Pharmacy CollegeAt. Ambav, Ta. Thasra, Dist. Kheda.
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PATIENT DETAILSNAME: XYZ AGE: 61year
WEIGHT: 75 kg INPATIENT No:68129
ADDRESS: BARODA
HOSPITAL NAME: BARODA HEART INSTITUTE AND RESEARCH CENTER, BARODA
D.O.A: 06/12/2007
CONSULTANT NAME: Dr. PANKAJ VYAS (M.D,D.M)
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• SOCIAL HISTORY: VegetarianSOCIAL HISTORY: Vegetarian
• FAMILY HISTORY: Father had cardiac problem.FAMILY HISTORY: Father had cardiac problem.
• DIAGNOSIS : Ischemic heart disease andDIAGNOSIS : Ischemic heart disease and obesityobesity
• ASSOCIATED DISEASE: NoneASSOCIATED DISEASE: None
• PAST MEDICATION HISTORY: NilPAST MEDICATION HISTORY: Nil
• COMPLAINTS: CHEST PAIN, COMPLAINTS: CHEST PAIN, HEAVYNESS HEAVYNESS
HAEMATOLOGY TEST RESULT NORMAL RANGE
HAEMOGLOBIN 10.0g/dl M-13-17, F-12-15
RBC Count 3.40mill/ cmm M-4.1-5.5, F-3.7-5.0
P.C.V. 30.3% 39-54
M.C.V. 89.12fl 83-92
M.C.H. 29.41pg 27-34
M.C.H.C. 33% 30-36
R.D.W.-D 14.6fl 12.0-17
WBC Count 8000/ cmm 4000-10,000
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DIFFERENTIAL WBC COUNT WBC RESULT NORMAL RANGE
NEUTROPHILS 64% 40-70
LYMPHOCYTES 34% 20-40
EOSINOPHILS 01% 1-6
MONOCYTES 01% 1-8
BAND CELL ----- -----
BASOPHILS ----- -----
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ESR- 1hr( Westerngreen Method) :- 28mm/hr (normal range – M-1-7, F-2-10)
BLOOD Group:- ‘A’ Rh Factor:- POSITIVE Platelet Count:- 165000/ cmm (1,50,000-
4,00,000)
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BIOCHEMISTRY TEST RESULT NORMAL RANGE
RANDOM PLASMA GLUCOSE
92mg/dl 70-140
SERUM CREATININE 1.40mg/dl 0.4-1.4
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COAGULANT TESTTEST
PROTHROMBIN TIMERESULT NORMAL RANGE
PROTHROMBIN TIME(TEST)
29.8secs 10-15
PROTHROMBIN TIME(CONTROL)
30.0secs 0-0
PROTHROMBIN RATIO
0.99% -
PROTHROMBIN INDEX 100.67% 70-4.5
INR 0.99 2.5-4.5
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ESTIMATION OF SERUM ELECTROLYTEMETHOD – AUTOMATIC AVL 9130 ELECTROLYTE ANALYZER
ELECTROLYTE REPORTED COUNT
NORMAL COUNT
SODIUM 135-4mEq/L 135 –145 mEq/L
POTASSIUM 4-06mEq/L 3.5-5.5mEq/L
CHLORIDES 92mEq/L 97-106mEq/L
ESTIMATION OF BLOOD SUGAR POST LUNCH {GOD-POD}
SUGAR AFTER 2 HRS OF LUNCH
120md/ml 125mg/ml
SECTOR ECHOCARDIOGRAPHY Ischemic Heart Disease Hypokinesia of Basal and Mid Inferior segments LV show concentric hypertrophy All cardiac chamber are normal in dimentions. LV systolic function is normal at rest [ LV EF-56%] E/o regional wall motion abnormality at rest. Cardiac valves are normal in structure & cxcursions. RVOT & MPA are normal, NO e/o mass/clot seen.
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COLOUR FLOW, CW, PW &HAEMODYNAMIC DATA Normal flow across all cardiac valves. LV diastolic dysfunction. No MR/ TR. trivial AR. No E/O Lt--> Rt shunt
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CONCLUSION Ischemic Heart Disease. Good LV systolic function. Concentric LVH with diastolic dysfunction. E/o resting regional wall motion abnormality. Mildly Sclerosed AV with Trivial AR. Normal PA
Pressures.
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MEDICATIONS:-DRUG NAME DOSAGE FORM DOSE USES
Cardace(ramipril)
Cap -2.5mg 1-tab in morning As Vasodilator to reduse b.p.
Clodrel-foret(clopidogrel+aspirin)
Tab-75+162-5mg 1-tab after lunch Inhibit platelet aggregation
Atocor(atorvastatin)
Tab-10mg 1-tab at bed time Decrees cholesterol level
Ecosprin (aspirin)
Tab-150mg 1-tab after lunch Inhibit platelet aggregation
Pantodac(Pantoprazole)
Tab-40mg 1-tab before meal Antacid
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DRUG INTERACTION ATOCOR [ATROVASTATIN] = 10-20mg
DONOT CONSUME WITH ALCOHOL, IF HEPATIC INSUFFICIENCY,COLESTIPOL, ANTACID, DIGOXIN ERTHROMYCIN.
CARDACE [RAMIPRIL] =1-5-5mg
DO NOT TAKE WITH NSAID’S AS IT REDUCES ITS ACTIVITY. CLODREL-FORTE [CLOPIDOGREL+ASPIRIN] = 75+162.5mg
DIGOXIN ,WARFARIN & WITH NSAIDS INCRESS G.I.T. BLOOD LOSS.
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TO AVOID… FASTING REFINED FLOUR LIKE MAIDA,SAGO. NUTS,WALNUTS,CASHEW,GROUNDNUT,PANEER,BUTTER. CANNED/TINNED FOOD. POTATO,BEETROOT,YAM,SAGO,RAW BANANA,SURAN. EGG YOLK. FAST FOOD/ AREATED DRINKS RICE AT DINNER TIME SWEET PRODUCTS WITH EXCESS GHEE. MUTTON,BEEF,PORK. ALCOHOL/ SMOKING/ TOBACCO AFTERNOON SLEEP.
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PREFER… WALK AT MORNING & NIGHT. HAVING FOOD AT RIGHT TIME 6 MEALS A DAY TO AVOID HYPOGLYCEMIA. CARRY SWEET IN POCKET TO AVOID HYPOGLYCEMIC STROKE. SKIMMED MILK. CONSUME MORE SALAD & VEGETABLE ONLY EGG WHITE OIL USE MUST NOT EXCEED(15gm)/DAY/PERSON. REGULAR EXERCISE. UNREFINED CARBOHYDRATE HAVE WHOLE FRUIT. REGULAR CHECK UP.
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PATIENT COUNSELLING EXPLAIN THE SIGNS AND SYMPTOMS OF CIRCULATORY EVENTS
CAUSE BY A TIGHT CAST THAT REQUIRES IMMEDIATE TREATMENT. DISSCUSS THE SIGNS AND SYMPTOMS OF EVENTS. TEACH THE PATIENT CAUSE OF ARM PAIN & TREATMENT. WEIGHT SHOULD BE CONTROLED. PATIENT IS REQUEST NOT TO ALTER DOSE OR CHANGE THE
DOSAGE FORM PATIENT SHOULD DUELY VISIT DOCTOR AND HAVE THEIR LIPID &
OTHER CONCERNE PROFILE UP DATEDED. DONOT PULL OR PUSH ANY HEAVIER LOAD. NO BRISK WALKING. YOGA EXERCISE SHOULD NOT INCLUDE EXTENSIVE STRECHING
OR UPSIDE DOWNING.
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REFERENCES:-
www.indiamediworld.com
www.drugdigest.com
Tripathi K.D, 2004 “ Essential Of Medical Pharmacology”, 5th Edition , Jaypee Publication Page No: 465,567,444 Drug Today, Vol-1&2, Ready reckner of current medical formulations, pg no-256,1264,271,717.
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