METFORMIN Type

II Diabetes FBS = 255 mg/dL

ASPIRIN
Activation
of AMP-
activated ↑ Free Fatty Acids Inhibition of
protein kinase Insulin Resistance platelet ↓ Thromboxane COX1
aggregation A2 Inhibition

Diabetic
↓ Hepatic ↓ Intestinal dyslipidemia
glucose absorption of ↑ Fibrocellular
↑ Adherence
production glucose ↑ Leukocyte
↑ Uptake of Oxidized of PLTs and and collagen
Lipid Profile Adhesion deposition in
Extracellular Lipids Macrophages
TC = 260 mg/dL to Endothelium Molecules endothelium
TG = 155 mg/dL
PERINDOPRIL
HDL = 40 mg/dL
↑ Foam Cells in
Inhibition of ACE LDL = 205 mg/dL
Tunica Intima 65 year old, Male
NITROGLYCERIN
↓ Conversion of
Smoking Plaque formation
angiotensin I TO Accumulation of Fat ↑ cGMP
angiotensin II in the Tunica Intima

↓ Endothelial Release of Ca2+ ions

Vasodilation Nitric Oxide
↑ Blood Vessel Wall
Thickness Relaxation of
smooth muscle cells Thrombus Formation
↓ Blood pressure ↓ Vasodilation

↑ Peripheral Vasodilation
Hypertension ↓ Blood vessel radius
resistance

↓ Coronary blood ↓ Coronary Blood

vessel radius Flow Chest pain
↑ Aortic Pressure aggravated by
↓ O2 delivery to walking 100 m
Sinus rhythm coronary circulation and relieved by
with ST segment rest
↑ Afterload depression and
T wave inversion Imbalance in O2
Myocardial Ischemia ↑ Metabolic
from V1-V4 ↑ O2 demand
supply and demand activity of the
↑ Cardiac workload heart
Total loss of O2 supply to SUPPLEMENTAL
↑ Troponin I
↓ Blood pressure: coronary circulation OXYGEN
100/60
↑ Left Ventricular
Pressure Release of cardiac
MYOCARDIAL muscle marker enzymes
↓ Ejection fraction: ↑ Energy
40%
INFARCTION Requirement for
↑ Width of Apex beat
cardiomyocytes at 6th LICS AAL Contraction

Chest Pain,
↓ Stroke volume radiating to left
Eccentric Left Cardiomegaly
↑ Left ventricular arm
wall thickness Ventricular
Hypertrophy with
↓ Cardiac contractility hypokinesia of ↑ Left ventricular Left Ventricular
anteroseptal wall mass Dilation
Concentric Left
Ventricular ↓ Ventricular wall ↓ End diastolic Cardiac Volume ↑ Length of
Hypertrophy compliance volume Overload cardiomyocytes

LEGEND
History Laboratory Result DRUG SUBSECTION B2
Signs and Symptoms DIAGNOSIS Mechanism
May 2016