CASE STUDIES ON
CARDIOVASCULAR DISEASES
(CASE STUDY #2)
ABAD, AGUSTIN, ALMAZAN, ALMAZAR, ARGUEL, BRIONES
BACKGROUND OF THE
DISEASES
A. DEFINITION OF THE DISEASES
HYPERTENSION
Is another name for high blood pressure. It
can lead to severe complications and
increases the risk of heart disease, stroke, and
death.
JNC 7 BLOOD PRESSURE CLASSIFICATION
SYSTOLIC DIASTOLIC
Normal ≤ 120 ≤ 80
Pre-HTN 120-139 80-89
Stage 1 HTN 140-159 90-99
Stage 2 HTN ≥ 160 ≥100
A. DEFINITION OF THE DISEASES
HYPERCHOLESTEROLEMIA
is a condition characterized by very high
levels of cholesterol in the blood.
A. DEFINITION OF THE DISEASES
GASTROESOPHAGEAL REFLUX DISEASE (GERD)
is a long-term condition where acid from
the stomach comes up into the esophagus.
B. PATHOPHYSIOLOGY
B. PATHOPHYSIOLOGY
GENETIC INFLUENCES ENVIRONMENTAL FACTORS
Both of his parents
Smoking
had hypertention
His two brothers had
Drinking alcohol
hypercholesterolemia
Does not exercise
Eats fast food for
break fast and lunch
C. ETIOLOGY
Both of his parents had hypertension. (Hereditary)
Started smoking since 17 years old; and smoked about 1 pack a
day after being diagnosed with hypertension 15 years ago.
Drinks one can of beer daily, up to 3 cans in a week. Rarely drinks
hard liquor.
Does not use recreational drugs.
Does not exercise.
Eats fast food for breakfast and lunch.
Mr. Min Ho was diagnosed with hypertension 15 years ago, and it was
known that both of his parents had hypertension, which is one of the main
causes of his disease. With his GERD, eating large amount of food from fast
food chains affects production of acid and causes high cholesterol level.
D. CLINICAL MANIFESTATIONS
1. Mr. Min Ho’s final reading of blood pressure is 192/124 mmHg.
2. he did almost pass out while trimming trees
3. He had an episode of dizziness
4. He felt like he was going to pass out but never did
5. He also gets short of breath more easily in the past few weeks and
has felt a loss of energy over this same time period.
6. He feels nauseated when exerts himself at work, but never
vomited
E. INCIDENCE
• According to the latest WHO data published in 2017 Hypertension Deaths in
Philippines reached 14,751 or 2.38% of total deaths. The age adjusted Death Rate
is 23.56 per 100,000 of population ranks Philippines #44 in the world.
• Based on the national survey released by the Department of Health in 2017, the
total number of hypertensive Filipinos is now more than 12 million, with more
than half of them are unaware of their condition. Roughly, that is one out of four
to five Filipinos in general. 70 percent to 79 percent of men ages 55 and older are
now classified as having hypertension.
F. DEFINITIVE DIAGNOSTICS
• i. LABORATORY TEST
BLOOD CHEMISTRY TEST RESULT
Sodium 140 mEq/L
Potassium 4.0 mEq/L
Chloride 100 mEq/L
Carbon dioxide 28 mEq/L
Blood Urea Nitrogen 14 mg/dL
Serum creatinine 1.1 mg/dL
Glucose 100 mg/dL
HEMATOLOGY TEST RESULT
Hemoglobin 13.8 g/dL
Hematocrit 44.0%
White Blood Cells 6.6 X 103/mm3
Platelet 222 X 103/mm3
LIPID PANEL TEST RESULT
Cholesterol 196 mg/dL
High Density Lipoprotein 36 mg/dL
(HDL)
Triglycerides 142 mg/dL
Low Density Lipoprotein 132 mg/dL
(LDL)
LIVER FUNCTION TEST RESULT
Aspartate Transaminase 27 IU/L
(AST)
Alanine Transaminase (ALT) 45 IU/L
URINALYSIS RESULT
Specific gravity 1.020
pH 5.8
F. DEFINITIVE DIAGNOSTICS
ii. DIAGNOSTIC PROCEDURES
• Urinalysis:
Negative for protein or blood; negative for recreational drugs
• Chest X-Ray
Enlarged heart, no infiltrates
• ECG
Normal sinus rhythm; LVH by voltage criteria
There are no STsegment changes, although there appears to be some T-
wave
flattening in the anterior leads.
G. STANDARD TREATMENT
MEDICATIONS:
Atenolol 100 mg once daily
Amlodipine 10 mg once daily
Lovastatin 20 mg once daily
OTC Famotidine PRN gastric reflux
CASE PROPER
A. PATIENTS DEMOGRAPHIC DATA
Patient Name: Min Ho
Age: 55 years old
Gender: Male
Allergies: None
Status: Married
Major diagnosis: HTN, Hypercholesterolemia and Gastroesophageal
reflux.
B. HISTORY
Medication History:
Mr. Min Ho has been taking drugs for hypertension for 15
years;
Atenolol 100mg
Amlodipine 10mg
For cholesterol (10 years):
Lovastatin 20mg
For GERD (25 years):
Famotidine (as needed, every other day)
B. HISTORY
Family History:
Mr. Min Ho’s parents had hypertension, and 3 out of 4 among his
siblings also suffer from hypertension and hypercholesterolemia.
Social History:
Works as a groundskeeper at a cemetery
Smokes cigarettes about one pack per day
Drinks about one beer daily, up to 3 cans on weekends
Does not exercise
Eats fast food
C. CHIEF COMPLAIN
Mr. Min Ho didn’t feeling well lately and figured maybe his
blood pressure was high.
D. REVIEW OF SYSTEMS
• - No visual disturbances or hearing problems
• - Denies headache, palpitations and chest pain, but states that he
did almost pass out while trimming trees a couple of weeks ago.
• - He had an episode of dizziness and had to sit down.
• - He also felt like he was going to pass out but never did
• - Shortness of breath more easily in the past few weeks and felt loss
of energy over the same time period.
• - He feels nauseated when he exerts himself at work, but has never
vomited.
• - He denies any muscle weakness or mental status changes.
E. PHYSICAL EXAMINATION
General
The patient is a middle-aged Hispanic man appearing to be in no
acute distress.
Vital Signs
BP: 200/120 mmHg right arm, 198/122 mmHg left arm 192/124 mmHg
(Repeat of measurement in the right arm after several minutes)
= Abnormal
PR: 58 bpm = Normal
RR: 24 bpm = Abnormal
Temp.: 36.8˚C = Normal
Weight: 72 kg
Height: 5’7’’
E. PHYSICAL EXAMINATION
Skin
Cool to touch
Good turgor = Normal
HEENT
Pupils Equal Round Reactive to Light and Accommodation (PERRLA) = Normal
Extra Ocular Movement Intact (EOMI) = Normal
Funduscopic exam revealed arterial tortuosity = Abnormal, but no nicking,
hemorrhages or exudates
Oropharynx clear = Normal
Neck/Lymph Nodes
Neck supple = Normal
No JVD = Normal
No bruits = Normal
No thyromegaly = Normal
E. PHYSICAL EXAMINATION
Cardiovascular
Point of maximal impulse shifted laterally = Abnormal
Regular Rhythm Rate (RRR) = Normal
No murmurs or rubs appreciated = Normal
+S4 heard at apex = Abnormal
Abdomen
Soft = Normal
Non-tender (NT) or Non-distended (ND) = Normal
No guarding = Normal
+Bowel Sound (BS) = Normal
No Abdominal bruits = Normal
Liver span about 12 cm = Abnormal
Genitourinary or Rectal
Normal male genitalia = Normal
Heme-negative stool = Normal
E. PHYSICAL EXAMINATION
Neurological
Alert and oriented (A & O x 3) = Normal
Cranial nerve II-XII intact = Normal
Motor or Sensory = Normal
Deep Tendon Reflexes (DTRs 2+) = Normal
F. DIAGNOSTICS
BLOOD CHEMISTRY TEST RESULT FINDINGS
Sodium 140 mEq/L Normal
Potassium 4.0 mEq/L Normal
Chloride 100 mEq/L Normal
Carbon dioxide 28 mEq/L Normal
Blood Urea Nitrogen 14 mg/dL Normal
Serum creatinine 1.1 mg/dL Normal
Glucose 100 mg/dL Normal
F. DIAGNOSTICS
HEMATOLOGY TEST RESULT FINDINGS
Hemoglobin 13.8 g/dL Low hemoglobin
(Abnormal)
Hematocrit 44.0% Normal
White Blood Cells 6.6 X 103/mm3 Normal
Platelet 222 X 103/mm3 Normal
F. DIAGNOSTICS
LIPID PANEL TEST RESULT FINDINGS
Cholesterol 196 mg/dL Normal
High Density Lipoprotein 36 mg/dL Low HDL (Abnormal)
(HDL)
Triglycerides 142 mg/dL Normal
Low Density Lipoprotein 132 mg/dL High LDL (Abnormal)
(LDL)
F. DIAGNOSTICS
LIVER FUNCTION TEST RESULT FINDINGS
Aspartate Transaminase 27 IU/L Normal
(AST)
Alanine Transaminase (ALT) 45 IU/L Normal
URINALYSIS RESULT FINDINGS
Specific gravity 1.020 Normal
pH 5.8 Normal
Protein Negative Normal
Blood Negative Normal
F. DIAGNOSTICS
CHEST X-RAY
Enlarged heart = Abnormal
No infiltrates = Normal
ELECTROCARDIOGRAM
Normal sinus rhythm = Normal
Left Ventricular Hypertrophy (LVH) by voltage criteria = Abnormal
There is no ST segment changes, although there does appear to
be some T-wave flattening in the anterior leads = Abnormal
G. TREATMENT
MEDICATION INDICATION DOSAGE MOA
-For the management of
hypertension and long- -inhibiting
100mg once
1. Atenolol term management of sympathetic
daily (Tablet)
patients with angina stimulation
pectoris
- inhibiting the influx
- treatment of HTN. 10mg once of calcium ions
2. Amlodipine
Prophylaxis of angina daily (Tablet) through L-type
calcium channels.
G. TREATMENT
MEDICATION INDICATION DOSAGE MOA
-mimics the
tetrahedral
intermediate
produced by the
- reduces levels of "bad" reductase allowing
cholesterol (LDL) while 20mg once the agent to bind
3. Lovastatin
increasing levels of daily (Tablet) to HMG-CoA
"good" cholesterol (HDL). reductase with
20,000 times
greater affinity
than its natural
substrate.
- For the treatment of
peptic ulcer disease
20mg once -blocking histamine
4. Famotidine (PUD) and
daily (Tablet) affects.
gastroesophageal reflux
disease (GERD).
H. THERAPEUTIC MONITORING
• The patient must undergo regular monitoring of blood pressure regarding his
hypertension and run tests necessary for his other conditions.
• Must lessen the use of cigarettes and alcohol intake.
• A change in lifestyle would be another helpful step.
• Avoid regularly eating in fast food chains.
• Must consult physician for further instructions regarding his medication; if
there is a need in changes.
I. PHARMACY INTERVENTION
NON-COMPLIANCE
He stop his medication for over a month, which is wrong
even if he said he was feeling fine.
Mr. Min Ho admits to not having a home blood pressure
monitoring device and has never routinely monitored his
blood pressure
I. PHARMACY INTERVENTION
A. SUBJECTIVE DATA
Dizziness
Lightheadedness
shortness of breath
Loss of energy
Feel nauseated
B. OBJECTIVE DATA
BP: 192/124 mmHG
PR: 58 bpm
RR: 24 bpm
Temperature: 36.8 °C
Weight: 72 kg
Height: 5’7
I. PHARMACY INTERVENTION
B. OBJECTIVE DATA
Laboratory examination
Hemoglobin: Decreased/Low
HDL: Decreased/Low
LDL: Increased/High
Chest X-Ray: Enlarge Heart
Point of maximal impulse shifted laterally
+S4 heart sound at apex
C. ASSESSMENT:
Coronary Artery Disease
Congestive Heart Failure
Cardiomyopathy
Coronary Artery Disease/ Coronary Heart Disease
Reduces the amount of blood the coronary arteries can deliver to the
myocardium.
Cardiomyopathy
Disease of the myocardium of unknown cause or occurring secondarily to other
disease; results in weakened cardiac muscle, causing all chambers of the heart
to enlarge; may eventually lead to Congestive Heart Failure
Congestive Heart Failure
Refers to the stage in which fluid builds up around the heart and causes it to
pump inefficiently.
I. PHARMACY INTERVENTION
D. PLAN
NON-PHARMACOLOGIC TREATMENT
Lifestyle change
Stop smoking
Exercise
Eat healthy diet
Reduce salt intake
Lipid lowering therapy
I. PHARMACY INTERVENTION
D. PLAN
PHARMACOLOGIC TREATMENT
Losartan
Amlodipine
Lovastatin
Famotidine
J. OUTCOME
The goal is to reduce his blood pressure up to130/90 mmHg
Reduce morbidity and mortality
Decrease LDL cholesterol to a target level of less than 100 mg/dL
K. SUMMARY
In this case, the first thing the patient must have done is to comply
with medications prescribed to him by his physician.
Non compliance with the prescribed medications will only worsen
one’s condition, specially if it is already in the state of
maintenance.
