1. CASE PRESENTATION ON
MYOCARDIAL INFARCTION
PRESENTED BY:
P.DIVYA POOJA
Y17PHD0822
II/VI PHARMD
NIRMALA COLLEGE OF PHARMACY

2. BRIEF SUMMARY OF CASE
• A 45 years old male patient was admitted in
hospital with chief complaints of retrosternal
pain, breathlessness.
• He had a past history of HTN with no familial
histories.
• He is a known smoker and alcoholic since past
10 years.
• This case was evaluated in SOAP format

3. SUBJECTIVE
• A 45 years old male patient was admitted in hospital
with chief complaints of retrosternal pain,
breathlessness. His pain is insidious in onset, while
patient is sleeping, constricting and radiating type of
pain to jaw and is associated with palpitations.
• He had a past history of HTN and no familial histories.
• He is a known smoker and alcoholic since past 10
years.
• His bowel & bladder habits are normal with normal
appetite and sleep patterns.

4. OBJECTIVE
• Physical examination-
Conscious
Temperature-98 c
BP-130/80 mm of hg
PR-80 beats/min
RR-24 cycles/min
• Systemic-
CVS-S1S2+
CNS- NFND
RS- BAE+
P/A- Soft

5. BIOCHEMICAL-
RADIOGRAPHICAL-
ECG: Normal sinus rhythm
Abnormal ECG
2D ECHO: CAD RWMA+LAD
Moderate LV systolic dysfunctioning
S.NO. PARAMETER OBSERVED VALUE NORMAL VALUE
1. Serum creatinine 0.80 mg/dl 0.90-1.30
2. Hemoglobin 13.8 g/dl 14.0-18.0

6. ASSESSMENT
• Based on the subjective and objective data,
the final diagnosis was found to be AWMI.
• Definition: Anterior ST segment elevation
occurs when anterior myocardial tissue usually
supplied by the left anterior descending
coronary artery suffers injury due to lack of
blodd supply.
• It is the most common symptom of ACS.

7. ETIOLOGY & RISK FACTORS:
• Smoking and alcohol intake
• HTN
• Age
• Stress
• Obesity

8. PATHOPHYSIOLOGY

9. CLINICAL PRESENTATIONS
• Chest pain, heaviness, tightness
• Pain is observed in neck, shoulder and left arm
• Dysopnea
• Nausea & Vomiting
• Diaphoresis
• Anxiety
• Arrhythmia

10. STANDARD TREATMENT
• Anti-platelet
• Thrombolytics
• Statins, ACE inhibitors

11. PLAN
GOALS-
• To reduce chest pain
• To get symptomatic relief
• To avoid further complications
• To decrease the disease progression

12. DRUG CHART
S.NO BRAND GENERIC DOSE ROA FRE CATEGORY INDICATION
1. T.DYTOR PLUS Spironolact
one
Torsemide
50+
10 mg
p/o OD Diuretic To treat HTN
2. T.CLOPILET Clopidogrel 75mg p/o BD Anti platelet To reduce
clot
3. T.STORVAS Atorvastati
n
40mg p/o BD Statin To reduce
cholesterol
levels
4. T.ECOSPRIN Aspirin 150 mg p/o BD Anti-platelet To reduce
pain and clot
5. T.PANTOCID Pantoprazol
e
40 mg p/o OD PPI Prophylactic

13. DRUG INTERACTIONS
Moderate-
1. Aspirin x Clopidogrel – Unusual bleeding and severe abdominal
pain
Management – Change in therapy in case of bleeding
2. Statin x Clopidogrel- Statin reduces the effect of clopidogrel
Management – Monitor for altered efficacy of clopidogrel
3. Statin x Pantoprazole- May increase BV diameter, leads to liver
toxicity
Management – Discontinue therapy if CPK increases
4. Clopidogrel x Pantoprazole- Reduces the effect of clopidogrel
Management – Substituted by any H2 antagonist

14. PATIENT COUNSELLING
About disease-
• Also known as heart attack
• Occurs when there is a diminished blood
supply to heart which leads to myocardial
tissue damage. Often caused due to the
formation of plaque
• In this case, caused due to the excessive intake
of alcohol and presence of HTN.

15. About drugs:
• T.Clopidogrel- Administer without food
• T.Pantocid- Take 15-20 min before breakfast
• T.Aspirin- Administer with food/ full glass of
water to avoid GI symptoms

16. SPECIAL INSTRUCTIONS
• Include a variety of fruits, vegetables, whole
grains and low fat dairy products
• Start an exercise plan
• Quit smoking & limit alcohol
• Follow regular medications and checkups
• Avoid fatty meals
• Maintain BP levels

17. THANK YOU