CASE ON

HYPERTENSIVE HEART FAILURE

P R E S E N T E D B Y:
ME H A M E H TA
1722 8 0 8 88 0 1 2
P H A R M D. 6 T H YEA R
 PATIENT DEMOGRAPHICS

Name : XYZ COMPLAINS:

Age : 68 years • Breathlessness
• Sudden onset
Weight : 60 kgs
• Severe at rest – NYHA GRADE IV
Gender : Male

Medical History: H/O Admitted and treated as hypertensive heart failure. K/C/O HF, LVD,
HTN, DM, Thyroid

No H/O: Chest pains, Palpitations, Perspiration, Abdominal pain

DOA: 18/8/2022 DOD: 27/8/2022

SYSTEMIC EXAMINATION AND OTHER DIAGNOSTIC TESTS

VITAL SIGNS SYSTEMIC EXAMINATION OTHER DIAGNOSTIC TESTS

BP = 220/120 mmHg 1. CVS: S1, S2 present, 1.USG: Few calculi of average
TEMP = 980 F Sinus Tachycardia size 4mm in Right lower calyx
HR = 110 bpm with hydronephrosis
RR = 26 bpm present Right Kidney: 97 X 34 mm
SPO2 = 87% 2. GI: Soft, Tender Left Kidney: 104 X 42 mm
For BP, STAT Inj. LASIX (40MG)
3. RS: B/L crepts up to 2. 2D ECHO:
given – BP reduced to supra-scapular region LVEF: 30-35%
4. CNS: Conscious and RVSP: 44 mmHg
190/110 mmHg LV: HTN, concentric LVH,
SPO2 87% on RA – O2 mask Oriented Dilated LV size, Reduced LV
(87%) – 15L NRBM, increased compliance.
to 94%
 LAB PARAMETERS
LAB PARAMETER OBTAINED DATA NORMAL RANGE
Na+ 140 135 – 145 mEq/L
K+ 5.8 3.6 – 5.2 mEq/L
Cl- 108.6 97 – 107 mEq/L
Hb 10.5 g/dl 12 – 16 g/dl
TC/ N/ L 9400/ 36/ 56 4000-11,000/ µl, 40-60%, 20-40%
RBC 4.08 4.7 to 6.1 million/ µl
Platelets 2,55,000 1,50,000 – 4,50,000/ µl

S. Cr 1.98 mg/dl 0.6 – 1.2 mg/dl

HbA1C 5.67 4 – 5.6%
RBS 203 80 – 120 mg/dl
Trop I <0.01 0 – 0.04 ng/ml
Urea 42 13 – 43 mg/dl
 LAB PARAMETERS
LAB PARAMETER OBTAINED DATA NORMAL RANGE
Na+ 140 135 – 145 mEq/L
K+ 5.8 3.6 – 5.2 mEq/L
Cl- 108.6 97 – 107 mEq/L
Hb 10.5 g/dl 12 – 16 g/dl
TC/ N/ L 9400/ 36/ 56 4000-11,000/ µl, 40-60%, 20-40%
RBC 4.08 4.7 to 6.1 million/ µl
Platelets 2,55,000 1,50,000 – 4,50,000/ µl

S. Cr 17/2/22 18/2/22 19/2/22

1.98 mg/dl 20/2/22 0.6 –21/2/22
1.2 mg/dl 22/2/22
HbA1C 1.98 2.45
5.67 2.95 3 2.93
4 – 5.6% 2.66
RBS 203 80 – 120 mg/dl
Trop I <0.01 0 – 0.04 ng/ml
Urea 42 13 – 43 mg/dl
 ASSESSMENT

• DIAGNOSIS: Hypertensive Heart Failure with LVEF 25%

• ETIOLOGY: DM, HTN, Thyroid (and previously admitted
with similar condition.)
• NEED FOR THERAPY: The patients needs the therapy for
reducing and controlling symptoms – hence reducing the
complaints, to reduce the mortality rate and to lead a
healthy life.
STANDARD THERAPY
 MANAGEMENT
ON ADMISSION (IN ER) UNTIL DISCHARGE (SHIFTED TO WARD)
INJ LASIX (FUROSEMIDE) 40 MG IV IV CEFTRIAXONE 1GM 12HRLY
STAT P/O TAB. TORSEMIDE 10MG OD
IV NITROGLYCERIN P/O TAB. METROPROLOL 25MG OD
P/O TAB. CARVEDILOL 3.1 OD
INJ PANTOPRAZOLE
P/O TAB. NIFEDIPINE 20MG TDS
INJ ONDANSETRON P/O TAB. ISOLAZINE
15 LIT O2 through NRBM P/O TAB. DIGOXIN ½ ALTERNATE DAY
P/O TAB. CLOPIDOGREL 75MG OD
P/O TAB. ASPIRIN 150 MG OD
P/O TAB. ATORVASTATIN 40MG OD
P/O TAB. PANTOPRAZOLE + DOMPERIDONE 30MG OD
P/O SYP CREMAFFIN 30ML HS
 GOAL OF THERAPY

1. GENERAL GOAL – To reduce the morbidity and mortality rate of the patient.
2. Patient Specific Goal

GOAL
To reduce the complains
of breathlessness and
increased blood pressure
ACHIEVED
Yes. Patient discharged
from the hospital after 10
days of hospitalization
upon recovery.
 MONITORING PARAMETERS

1. ECG
2. BP
3. RFT, LFT, CBC
 POINTS TO PHYSICIAN
DRUG INTERACTION MECHANISM
Clopidogrel + Amlodipine Concomitant use may cause
decreased antiplatelet activity of
clopidogrel and increased risk of
thrombotic events
Amlodipine + Domperidone Concomitant use may cause
increased exposure of
domperidone and lead to QT
prolongation
Clopidogrel +Nifedipine Concomitant use causes reduced
antiplatelet effect and increased
risk of thrombotic events.
MANAGEMENT
Use caution during concomitant
use. Monitor patient’s symptoms
for evidence of drug interaction.
Use caution on concomitant use
of the drugs. Also, regularly
monitor ECG for noticeable
changes.
Continue monitoring patient
during co-administration of these
drugs.
 POINTS TO PATIENT

1. Hypertensive Heart Failure – Refers to the cardiac complication

arising due to increased blood pressure in the body.
2. Diabetes Mellitus – A condition in which the glucose levels in the
body are increased and the body is not able to digest the extra
glucose.
3. Hypertension – A condition in which the blood pressure in the
body remains increased.
LIFESTYLE MODIFICATIONS
 FOLLOW UP

Follow up after 1 month in medicine OPD