IHD WITH UNSTABLE ANGINA 12 Q 1326 SCENARIO

IHD WITH UNSTABLE ANGINA 12 Q 1326

�SCENARIO: Here is the male patient of age 60 yrs was admitted to the hospital with complaints of chest pain since morning 10 am radiating to arm and back pricking type and sweating and nausea �. �CHIEF COMPLAINTS: c/o chest pain since 10 am radiating to arm and back, pricking type sweating since 10 am �HISTORY OF PRESENT ILLNESS: Patient was apparently alright upto 10 am then he developed chest pain at Lmammary which is acute in onset and progressive in nature radiating to arm and back, pricking type. lasted for 5 minutes. sweating vigorously since 10 am then he lasted for 15 -20 min. nausea since 10 am acute in onset and progressive in nature.

�PAST MEDICAL HISTORY: Nothing significant �PAST MEDICATION HISTORY: Nothing significant �FAMILY HISTORY: Nothing significant �PERSONAL HISTORY: Nothing significant �SURGICAL HISTORY: Nothing significant

�LABORATORY INVESTIGATIONS: (why test performed): �CBC count: it is a blood test used to evaluate overall health and detect wide range of disorders<including anemia, infection, leukemia. sno Reference Values Test Values Result 1 Polymorphs(40 -60) 83 Increased 2 Lymphocytes(20 -60) 16 Decreased 3 MCV(80 -100)fl 105. 7 Increased 4 MCH(32 -36)g/dl 38. 1 Increased �ESR: it is useful for detecting inflammation in the body that may be caused by infection. use for diagnosing some cancers and certain autoimmune diseases.

sno Reference Values Test Values Result 1 ESR(mm/hr)M<10, F<20 20 Increased �CPK MB: this test is perfored to detect heart disease like IHD. this test is done after patient experiencing symptoms of heart diseases. this testvmeasures the level of creatine phosphokinase in the blood and used to detect muscle damage. sno Reference Values Test Values Result 1 CPK MB(0 -26)u/l 15 normal �LIPID PROFILE TEST: this test is used to identify hyperlipidemia of cholesterol and tryglycerides levels which are use for recognising cvs diseases.

sno Reference Values Test Values Result 1 Cholesterol(150 -250)mg/dl 313 Increased 2 VLDL(15 -45)mg/dl 98 Increased 3 Triglycerides(65 -170)mg/dl 249 Increased 4 LDL(90 -136)mg/dl 192 Increased ECG: this is performed to measure the electrical activity of our heart generates electrical signal which flows from heart to whole body. it can determine whether the heart is performing normally or suffering from abnormalities.

�SUBJECTIVE EVIDENCE: � complaints of chest pain radiating to arms and back, sweating since 10 am. and nause since 10 am. �OBJECTIVE EVIDENCE: �X-ray �DIAGNOSIS: based on laboratory investigations and subjective, objective evidence the patient diagnosed with IHD-UNSTABLE ANGINA.

MEDICATION CHART: sn Trade Name o Generic Name Dose Indicati on 1 2 3 4 5 6 7 1 gm antibiotic y y N N N 1 I. Kephazone 1 cefoperazo -0 -1 ne 2 I. Pantodoc 1 - pantoprazol 40 mg 0 -0 e PPI y y y N N 3 I. Vomikind 1 ondansetro -1 -1 n 1 amp Anti emetic y y y y 4 T. Sorbitrate (1 Isosorbide -1 -1) di nitrate 5 mg angina y y y y 5 T. Clopivast(0 -1 -0) 150 mg Anti platelet y y y Y 6 T. Tonact(0 -0 - atorvastatin 40 mg 1_ hyperlipi demia y y y y clopidogrel

sn o Trade Name 7 I. Hepanox -0 -1 8 T. Anxit 0 -0 -1 9 Generic Name Indicati on 1 2 3 0. 4 ml thrombo sis y N N N 0. 25 m Anxiety g y y y Y SYP. cremaffin Liquid plus paraffin 2 tsp y y y Y 10 I. Hapanox -0 -1 1 enoxaparin 0. 4 ml thrombo sis N N y y y N N 11 I. Ceftriaxone 1 -0 -1 ceftriaxone 1 gm antibiotic N N y 12 Cap. neopride 1 -0 -0 levosulpride psychose s N N N y 1 enoxaparin Alprazolam Dose laxative N 4 5 6 y 7 y

�ASSESSMENT OF EACH TEST: �ESR: ESR increased due to infection that associated with heart disease like IHD and angina. it is increased during inflammation. �POLYMORPHS: polymorphs are increased due to infection or inflammation. the role of polymorphs is to defend the body from microorganisms and substances which harm the body. when there is inflammation in the body the production may increases. �LYMPHOCYTES: Lymphocytes play an important role in the immunologic activity and produce antibodies. decreased lymphocytes causes decrease in immunity which leads to severe illness.

�PHARMACEUTICAL CARE ISSUES: No issues are found �MONITORING PARAMETERS: �Continuous ST-segment monitoring in unstable angina. �Oxygen supplement. �Monitoring cholesterol levels. �Reduce or prevent angina symptoms. �CONCLUSION: Based on laboratory interpretation the patient is diagnosed with IHD with UNSTABLE ANGINA.