CASE

PRESENTATION
CREATED BY- Pharmacology SGD 1A
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A 58-year-old female, came in with recent onset chest discomfort when jogging or swimming
vigorously. The pain is dull but poorly localized; it disappears after 5–10 minutes of rest. She also
presents with a blood pressure of 150/100 during her check up at the clinic. She admits on having
elevated blood during her visits in the clinic with BP range of 140-150/80 for the last month. She is a
known hypertensive for 5 years and is on Metoprolol 50 mg once daily. She is a nondiabetic and is
apparently healthy. She is living a sedentary lifestyle with occasional exercise and her meals are
mostly fast food. She is a non-smoker and non-alcoholic beverage drinker with a strong family history
of hypertension and coronary artery disease on both sides of the family.

Case as presented by the patient.

 • General Survey: awake, oriented, not in
respiratory distress
BP 150/100 HR 89 RR 18 T. 36.9 BMI
32kg/m2
HEENT: anicteric sclerae, pink palpebral
conjunctiva
Physical Skin: good turgor and mobility
Examination!! Chest/ Lung: ECE, CBS
CVS: distinct heart sounds, no murmur
! Abdomen: flabby, hypoactive bowel sounds,
not tender
GUT: unremarkable
Extremities: strong peripheral pulses, CRT
<2 sec
 • Lab: Fasting Lipid Panel
Total Cholesterol 300mg/dL
LDL 170mg/dL
HDL 38mg/dL
LABORATORY Triglycerides 300mg/dL
FINDINGS FBS 100mg/dL
ECG 12 leads: Sinus rhythm with slight left
ventricular hypertrophy
 Analyzing Laboratory Findings!!
LABORATORY Normal range ! Patient’s Laboratory Findings
COMPONENTS!

Total Cholesterol 125 – 200 mg/dL 300 mg/dL

LDL Less than 100mg/dL 170 mg/dL
HDL More than 50mg/dL 38mg/dL
TRIGLYCERIDES Less than 150mg/dL 300mg/dL
FBS Less than 100mg/dL 100mg/dL
 Most Probable Diagnosis:
• The patient is most like suffering from “ISCHEMIC HEART DISEASES”
• Symptoms that helps in diagnosis
• A) Stable Angina
• B) high cholesterol which causes lipid deposition on the sub endothelial of
the arteries leading to Atherosclerosis.
 DIFFERENTIAL DIAGNOSIS

A)
C) PULMONARY D) CHEST WALL
GASTROESOPHAGEAL B) PEPTIC ULCER
EMBOLISM INJURY
REFLUX

E) PNEUMONIA F) RIB INJURY

 Let’s understand ANGINA first!!
• Angina is a chest pain or discomfort that occurs when the heart muscle
doesn't receive enough blood and oxygen. This is due to a partial blockage
or narrowing of the coronary arteries, which supply blood to the heart
muscle. The resulting decrease in blood flow can cause chest pain or
pressure, which can be felt in the chest, neck, jaw, shoulder, arms, or back.
What does Angina feel
like?
 LET’S
UNDERSTAND THE
TYPES OF ANGINA.
 • PHARMACOTHERAPEUTIC GOAL-
• A) control angina symptoms
• B) reduce blood pressure
LET’S FOCUS
ON THE • NON PHARMACOTHERAPEUTIC
GOAL-
TREATMENT!
• A) Recommend lifestyle modifications such
as diet change and regular exercise (more
than 150 minutes per week)
 HOW TO ACHIEVE
PHARMACOTHERAPEUTIC GOAL-?
A) Initiate anti-anginal therapy to
manage the symptoms of angina.
Consider initiating a medication
such as nitroglycerin to provide
immediate relief during episodes of
chest discomfort.
B) Adjust current antihypertensive
therapy to achieve target blood
pressure levels. Consider adding or
adjusting antihypertensive
medications to achieve a blood
pressure goal of less than 130/80
mmHg for this patient with
established coronary artery disease.
 HOW TO ACHIEVE
PHARMACOTHERAPEUTIC GOAL-?
• C) Initiate lipid-lowering therapy to reduce elevated lipid levels and
mitigate the risk of coronary artery disease progression. Consider
starting a statin medication to target the elevated LDL cholesterol
levels and improve the patient's lipid profile.
A Suggested Prescription for the patient.
Continue Metoprolol
Initiate Atorvastatin
as prescribed but add a To elevate angina
40mg daily to address
CCB like Amlodipine Nitroglycerin 0.4mg
the elevated cholestrol
to lower the elevated PRN
levels
Diastolic pressure

Regular Aerobic Diet low in sodium, Promoting weight loss

exercise ( atleast 150 saturated fats and strategies to reduce the
minutes a week) cholestrol BMI
 MONITORING PARAMETERS:

01 02 03
A) Monitor blood B) Monitor lipid levels to C) Assess angina
pressure regularly to assess the response to symptoms and the
assess the response to lipid-lowering therapy frequency of episodes to
antihypertensive therapy and adjust treatment evaluate the effectiveness
and ensure target levels of anti-anginal therapy.
are achieved.
DESIRED END POINTS OF TREATMENT!

01 02 03
A) Achieve and maintain B) Attain and maintain C) Provide effective relief
target blood pressure optimal lipid levels, from angina symptoms
levels of less than 130/80 including LDL cholesterol and reduce the frequency
mmHg to reduce the risk levels below 100 mg/dL, and severity of angina
of cardiovascular events. to reduce the risk of episodes.
coronary artery disease
progression.
 • Schedule a follow-up visit in 4-6 weeks to
Follow assess treatment response, side effects, and
make further adjustments if necessary.
up!!
 • Monitor for potential side effects of
medications, especially any signs of
intolerance to the increased dose of
Metoprolol or Atorvastatin.
IMPORTANT . Emphasize adherence to the prescribed
CONSIDERATIONS!! medications and lifestyle modifications

Address any concerns or questions the

patient may have regarding the treatment plan.
 THANK YOU
FOR LISTENING
• “ ALWAYS KEEP
YOUR HEART
HEALTHY”