CASE PRESENTATION

OF UNSTABLE ANGINA

ADARSH VV
Reg.no.-16Q2601
Angina pectoris, commonly known as angina, is severe chest pain due to
ischemia (a lack of blood, hence a lack of oxygen supply) of the heart muscle,
generally due to obstruction or spasm of the coronary arteries (the heart's blood.
vessels).
It is caused by coronary blood flow that is insufficient to meet the oxygen demands
of the myocardium, leading to ischemia.
Sign and symptoms
DEMOGRAPHIC DETAILS
Patient name :abc
Patients age : 62 yrs
Sex :male
Ip number : ip66633
DOA :22-6-22
Ward :cardiology
SUBJECTIVE DATA
c/o chest pain on exertion even walking for a small distance
Past medical history :
K/C/O CAD,T2DM

Past medication history :

TAB.TELMA 40MG,TAB.ROZA GOLD,INJ.INSULIN,TAB.METFORMIN

Personal history :
Diet : Mixed
Appetite : Reduced
B&B : Regular
Sleep : Normal
OBJECTIVE DATA
Physical examination:
patient moderately built and nourished conscious cooperative weak
and dehydrated

VITALS
B.P : 120/70mmHg(120/80mmHg)
Respiratory rate : 24 BREATH/MIN(12-16)
LAB INVESTIGATION
Hematology
Parameters Observed values Normal values
Heamoglobin 13.8g/dl M:13.5-17.5g/dl
RBC (million cells/cu mm) 5millions/cu mm 4-6millions/cu mm
PCV 0.47% M: 0.44 - 0.54%
F : 0.37 - 0.47%

Parameter Observed value Normal value

Neutrophils 55% 40-70%
Lymphocytes 21% 20-45%
Eosinophils 0.1% 0-6%
Monocytes 9.3% 2-10%
Basophils 0% 0-1%
Electrolytes
parameters Observed value Normal values
Sodium 160mmol/L 135-147mmol/L
Pottassium 4.2mmol/L 3.4-5mmol/L
chloride 100mmol/L 98-107mmol/L

Liver function test

parameters Observed value Normal value

Total bilirubin 1.1mg/dl 0.2-1.3mg/dl

Dierect bilirubin 0.2mg/dl 0-0.3mg/dl

Indirect bilirubin 0.6mg/dl 0.1-1mg/dl

RBS:155mg/dl
Assessment
From above subjective and objective evidence and lab
investigation it was diagnosed as Unstable angina, normal
lv dysfunction,diabetes,hypertension
PLAN
Goals of the treatment
1.To relieve pain.
2.To prevent or limit mayocardial infraction or ischemia
3.Stabilizing any plaques that may have ruptured in order
to prevent a heart attack.
4.Relieving symptoms.
5.Treating the underlying coronary artery disease (cad)
TRADE NAME GENERIC NAME DOSE FREQUEN ROUTE 1 2 3 4 5 6 7
CY

TAB.PANTOP PANTOPRAZO 40MG 1-0-1 ORAL       

LE
INJ.HEPARIN HEPARIN 5000IU Q6HR IV       

TAB BETALOC METOPROLO 1-0-1 ORAL       

L
TAB.ISORDIL ISOSORBIDE 10MG 1-1-0 ORAL       
DINITRATE

TAB.METFOR METFORMIN 500MG 0-0-1 ORAL       

MIN

TAB.TELMA TELMISARTA 40MG 0-0-1 ORAL     

N
DISCHARGE MEDICATION
• TAB.ISORDIL 1-0-1
• TAB.METFORMIN 500MG 1-0-0
• TAB.RAZEL GOLD 10MG 0-0-1
• TAB.PAN 40MG 1-0-0
• TAB.BETALOC 1-0-1
Patient counseling
Lifestyle based
• Smoking cessation is mandatory to prevent recurrent cardiac events.
• Lipid-lowering should try and obtain a target LDL-C level of 70 mg/dl or
lower, an HDL level of at least 35 mg/dl, and a triglyceride level of less than
200 mg/dl.
• The patient should exercise and eat a low-fat diet.
• Control your Hypertension the target blood pressure should be below 140/90
mm Hg, at the same time should decrease the intake of sodium and alcohol
• Diabetes Mellitus Management:Blood sugar levels may be decreased with
diet, exercise, or pharmacotherapy.
• Weight Management and Nutrition:should lose weight and achieve a body
mass index (BMI) of 25 kg/m
• Activity Management:Since you have a risk for unstable angina should avoid
intense physical activity, especially in cold weather.
Drug based
• Have pantop atleast 30 minutes before food.
• Precuations on taking Isordil:do not drive,use echianery,or anything
that require alertness
• Precuations on taking Metformin:avoid alcohol as it may cause low
blood sugar,do not take other medications unless they have been
discussed with doctor