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    Case 18 Systemic Hypertension With Dilated

    Uploaded by

    Shekh Aatif
    Case study of patient with systemic hypertension Diated

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    © All Rights Reserved
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    Case 18 Systemic Hypertension With Dilated

    Uploaded by

    Shekh Aatif
    1 views5 pages
    Case study of patient with systemic hypertension Diated

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    © © All Rights Reserved

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    Case study of patient with systemic hypertension Diated

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    1 views5 pages

    Case 18 Systemic Hypertension With Dilated

    Uploaded by

    Shekh Aatif
    Case study of patient with systemic hypertension Diated

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Download as docx, pdf, or txt
    of 5

    CASE OF SYSTEMIC HYPERTENSION WITH DILATED

    CARDIOMYOPATHY WITH CARDIAC EJECTION FRACTION 30%.

    PATIENT DEMOGRAPHIC DETAILS

    Patient profile
    Name : ABCD
    Ward : Male Medicine Ward
    Age : 59 yrs
    Sex : male
    Hospital : Nims hospital

    PRESENTING COMPLAINTS

     Difficulty in breathing X 3 days


     Abdominal pain X 3 days

    PAST HISTORY

     H/o systemic hypertension.


     No h/o DM/TB/Epilepsy
     No h/o previous surgeries.

    Personal history

     Married
     Smoker (stopped now)
     Non alcoholic
    Family history

     NiL

    KNOWN ALLERGIC

     NIL

    SOAP ANALYSIS OF OF SYSTEMIC HYPERTENSION WITH DILATED


    CARDIOMYOPATHY WITH CARDIAC EJECTION FRACTION

    Subjective evidence:

     Difficulty in breathing X 3 days


     Abdominal pain X 3 days

    OBJECTIVE FINDINGS

    PARAMETERS DAY 1 DAY 2 DAY 3

    PULSE RATE 89 89 92
    (per min)
    BLOOD PRESSURE 90/60 120/70 115/70
    (mm of Hg)
    TEMPERATURE 102 102 99
    (degree F)

    Lab investigations

    Parameters Result Normal values


    AST/SGOT 44 U/L 0-35(g/dl)
    ALT/SGPT 39.0 U/L 0-35(g/dl)
    Serum alkaline phosphate 124 IU/L 80-290(g/dl)
    Serum total protein 6 g/dl 6-8(g/dl)

    Other investigation

    Renal function

     Serum urea (10-50 mg/dl) - 33.3mg/dl


     Serum creatinine (0.6-1.6 gm/dl) – 1.34mg/dl

    Ultrasonography

     Prostatic calcification noted.


     Impression: normal study

    Assessment

    GOAL OF THERAPY–
     To eliminate the patient's symptoms
     To focus on minimum ADRs, with maximal drug effectiveness
     To focus on using minimum number of drugs
     To improve QoL.

    Treatment given
    RDA DRUG DOSE FREQUENC DATE STARTED DATE STOPPED
    Y
    IV INJ.LASIX 1amp BD 25/8 29/8
    IV INJ. RANTAC 5/50 BD 25/8 29/8
    IV INJ. CEFONUS 1.5g BD 25/8 29/8
    IV TAB. PAN 40 40 mg SOS 28/8 30/8
    P/O T AB. RAMIPRIL 2.5mg OD 26/8 30/8
    P/O NEBULIZATION TDS 25/8 30/8
    P/O TAB. CARDIOVAS 3.125mg BD 25/8 30/8
    P/O TAB. RIVOTRIL 0.5 mg HS 25/8 30/8
    P/O TAB. ALDACTONE 150 mg BD 26/8 29/8
    P/O TAB. DYTOR 20/50 BD 28/8 30/8
    P/O SYP. MUCAINE 2 tsp TDS 29/8 30/8
    GEL
    P/O TAB. DIGOXIN 0.25 mg OD 29/8 30/8
    P/O TAB. SPORLAC 2 tab BD 30/8 30/8
    P/O TAB. OFLOX 0.2 g BD 30/8 30/8

    INDICATION OF PRESCRIBED DRUG


     Lasix (furosemide) is a loop diuretic (water pill) that prevents body from absorbing
    too much salt, allowing the salt to instead be passed in your urine.
     Pantoprazole is a substituted benzimidazole used in NSAID induced ulcer
    prophylaxis.
     Ramipril is an antihypertensive ACE inhibitor.
     Cardiovas contains carvedilolan α blocker.
     Oflox contains ofloxacin which is a synthetic broad spectrum anti microbial agent.
     Sporlac is a probiotic containing lactic acid.
     Dytor is a fixed combination of torsemide a loop diuretic and spironolactone used to
    treat edema indicated in the patients.
     Digoxin is a cadiac glycoside used to treat heart failure.
     Rivotril contains clonazepam which is a benzodiazepine to control seizures.
     Aldactone is a spironolactone to treat hypertension and heart failure.
     As an adjunct in the treatment of esophagitis and peptic ulcer.

    Pharmaceutical issues
     Diuretic must be reduced or discontinued with concomitant use of ramipril.
     Close therapy monitoring needed as multitude of drugs are used.
     Fluoroquinolones, including ofloxacin, are associated with an increased risk of
    tendinitis and tendon rupture in all ages. This risk is further increased in older
    patients usually over 60 years of age, in patients taking corticosteroid drugs.
    Suggestion for optimization of therapy
     Innate counseling
     Monitoring drug side effects.
     Cardiovas must not be suddenly withdrawn as this may cause bradycardia.
     Signs for tendinitis must be carefully monitored.
     Documentation of treatment regimen
     Clinical follow up care

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