CASE PRESENTATION ON

ISCHEMIC CARDIOMYOPATHY
& CCF.

Presented by:
Name: maliha muzaffer
Roll no: 170318882004
MESCO COLLEFE OF PHARMACY
 Introduction
ISCHEMIC CARDIOMYOPATHY:- It is a condition
that occurs when the heart muscle is weakened. In this condition
the LV(left ventricle) which is the muscle is usually enlarged and
dilated. This condition can be a result of heart attack or
CAD(coronary artery disease), a narrowing of the arteries .It is a
general term for any Cardiomyopathy caused by inadequate
oxygen delivery to heart muscle, usually because of CAD.

CONGESTIVE CARDIAC FAILURE(CCF):- It

occurs when the heart is unable to pump sufficiently to maintain
blood flow to meet the bodies need , which leads to SOB,
excessive tiredness and leg swelling
 SUBJECTIVE DATA:
CHIEF COMPLAINT:
A patient was admitted to the casualty with complaints of generalized swelling of body since 15 days insidious
smacking with feet and extending upwards.

HISTORY OF PRESENT ILLNESS:

*SOB of grade-IV
*Patient is C/C/C
Orthopnoea+, PND+(paroxysmal nocturnal dyspnoea)

PAST MEDICAL HISTORY:

* Diabetes mellitus type-II since 3 years on medication with Oral hypoglycemic class-II(BIGUANIDE).
•Drainage of abscess on neck 2 month ago & had a surgery 1 month ago

FAMILY HISTORY:

*MOTHER ( DIABETIC )

* ADDICTION:
* Chronic smoker
 OBJECTIVE DATA

DAY-1 DAY-2 DAY-3 DAY-4 DAY-5

PULSE 102/MIN 88/MIN 86/MIN 86/MIN 88/MIN
RATE=
BLOOD 110/70 120/80 120/80 130/90 130/90
PRESS mm hg mm hg mm hg mm hg mm hg
URE=

TEMPE
RATUR normal normal normal normal normal
E=

105-130 160 200 180 145

 LAB INVESTIGATIONS
BIO CHEMICAL TESTS URINE ANALYSIS
UREA: 28 mg/dl BLOOD: - WBC: -

PROTEIN: 156 RBC: --

Serum creatinine: 1.3 mg/dl MG/DL

Na+ : 136 meq/L SUGAR: -- EPI. CELL: --

CREATININE: 81 CRYSTALS: --
K+ : 3.5 meq/ L MG/DL
 OTHER INVESTIGATIONS
✔ 2D Echo
✔ ECG
✔ CPS
 IMRESSIONS:-

* 2D Echo:- All dilated chambers.

* Severe LV dysfunction
•Modified TR1 DAH

▪ ECG :- Low voltage complexes, poor R wave progression.

CPS:- Complexes in V1 to V4.

ASSESSMENT

Based on above Subjective and objective data

patient was diagnosed with Ischemic
Cardiomyopathy with severe LV dysfunction ,
CCF(chronic congestive failure).
FORMULA DRUGS: GENERIC DOSE: ROUTE: FREQUENC
TION: NAME: Y:
INJ Lasix furosimide 40 mg IV BD

INJ Pantop Pantaprozol 40 mg IV OD

e
TAB Atorva Atorva statin 40 mg ORAL OD

TAB Aspirin Salicylate 150 mg ORAL OD

TAB Enam Enalapril 2.5 mg ORAL BD

TAB Met XL Metaprolol 12.5 mg ORAL OD

TAB Digox Digoxin .25 mg ORAL OD

TAB Clopivas Clopitogrel 75 mg ORAL OD

TAB Pantop Pantaprozol 40 mg ORAL OD

e
TAB Metformin Metformine 500 mg ORAL BD
 DRUGS M.O.A
Loop Diuretics – Inhibit
1. LASIX reabsorption of Na+ & cl-
ions by interfering chloride
binding site
Inhibits gastric action
2. PANTOP production.
Hmg co reductase.
3. ATORVA Inhibition effect.
Inhibits PG synthesis by
4. ASPIRIN COX-1 & COX-2.
Inhibits conversion of
5. ENAM angiotensin 1-2.
Blocks beta 1 adrenergic
6. MET-XL receptors in heart muscles
cells. Reduce sodium
uptake & slowing down
potassium release.
Induces increase in
7. DIGOX intracellular Na that will
ADVERSE EFFECTS
Hyper urecimia,
hypo kalemia, anemia,
diarrhea.
Facial & generalized edema,
abdominal pain.
Ataxia, nausea, diarrhea,
arthralgia.
Angio edema, broncho
spasm, CNS alteration.
Bradichardia, dizziness,
hypo tension, cough.
Slow heart rate,
breathlessness, dizziness,
fatigue.
Dizziness, mental
disturbance, head ache,
DRUG INTERACTIONS :
❖ Furosemide Metformin
When used together may increases effect of metformin which may lead to a
life threatening condition called “Lactic Acidosis” . This can cause weakness,
sleepiness, slow heart rate ,SOB, muscle pain, stomach pain, fainting, feeling
light-headed etc.

❖ Pantoprazole Furosemide
When used together it lead to a condition called as ’’hypomagnesemia’’ or low
blood Mg levels. This condition can occur due to the prolong use of PPI (proton
pump inhibitor).The risk may further when combination with other medication

❖ Pantoprazole Clopitogrel
when combined together may reduce the effectiveness of clopidogrel in preventing
heart attack or strokes.
 ❖ Digoxin Aspirin
This combination may lead to nausea, loss of appetite,
visual changes, slow pulse or irregular heart beat .To
take this medication safely together you may need dose
adjustment.

❖ Metaprolol Digoxin
Using together may slow the heart rate
and lead to in the side effects. If
prescribing together need dose
adjustment.
 ❖ Atorvastatin Clopidogrel
this combination may reduce the effect of clopidogrel
which is anti platelet.

❖ Aspirin Clopidogrel
This combination can cause unusual bleeding, severe
abdominal pain , weakness and appearance of black –
tarry stools.

❖ Enalapril Furosemide
This combination can lead to blood pressure.
❖ Enalapril Aspirin
if taken in combination it can have a negative
role on B.P and kidney .It may need dose adjustment
for the administration.
 PLANNING
❖ Fluid restriction per day < 1lt
❖ Salt restriction per day < 2gm
❖ Loop Diuretic
❖ Antacid
❖ Anti Platelet
❖ Analgesic, Anti platelet
❖ ACE inhibitor
❖ β1 receptor blocker
❖ Oral hypoglycemic
GOALS OF THERAPY
✔ Reduce symptoms and improve quality of life.
✔ Slow disease progression.
✔ Reduce the need of emergency room visits &
hospitalization
✔ Maintain the blood-sugar levels.
✔ To reduce the B.P(blood pressure).
 PATIENT COUNSELING
PATIENT COUNSELLINN REGARDING MEDICATION:-
1. Take the medications on time as per the prescription
prescribed.
2. In case of miss dose avoid over dose.
3. Do not have the new medications until and unless it is
prescribed by a consultant physician.
4. Keep investigating your B.P and GRBS levels routinely.
5. In case of any interaction symptoms immediately consult to
your physician.
PATIENT COUNSELLING REGARDING DIET:-
1. Avoid excess salt in diet
2. Follow healthy diet like Low cholesterol
3. No transfat
4. Don’t smoke and avoid second hand smoking.
5.Avoid (or) limit caffeine intake

PATIENT COUNSELLING REGARDING LIFE

STYLE MODIFICATION

1. Lose weight.
2. Exercise.
3. Avoid stress by techniques such as meditation and
biofeedback
Thank you