CASE PRESENTAION
Diastolic Heart failure
Presented By
Bimlendra Yadav
II PHARM D
Reg no:22Q0039
Acharya & BM Reddy College of Pharmacy, Bengaluru
DEMOGRAPHIC DATA
IP NO :56XXXXXX139
INITIALS: MR/MS XYZ
AGE / SEX : 42 / F
DEPARTMENT : General medicine
DATE OF ADMISSION : 5/2/24
DATE OF DISCHARGE : 8/2/24
Acharya & BM Reddy College of Pharmacy, Bengaluru
SUBJECTIVE DATA
CHIEF COMPLAINTS:
Pt. Was brought to triage unresponsiveness since morning and easy fatiguability
GRBS-58mgld after iv deration patient improved.
HISTORY OF PRESENT ILLNESS:
NA
Acharya & BM Reddy College of Pharmacy, Bengaluru
PAST MEDICAL AND SURGICAL HISTORY:
K/C/O HTN×9 Yrs
K/C/O cardiac sarcoidosis-DOM(9Yrs back)
MEDICATION HISTORY:
SOCIAL HISTORY
Smoking : never used
Alcohol : N/A
Diet: 3meals/day, type-mixed, water intake -3 glasses/day
Habits-appetite-decrease
. Bowel-normal
. Bladder-regular
OBG HISTORY:
Menstural history –regular
ALLERGIES: Nothing significant
Acharya & BM Reddy College of Pharmacy, Bengaluru
OBJECTIVE DATA
GENERAL EXAMINATION:
Moderately built& nourished now conscious, oriented to time, place
PHYSICAL EXAMINATION: (PICCLE/PICKLE)
Acharya & BM Reddy College of Pharmacy, Bengaluru
SYSTEMIC EXAMINATION
Acharya & BM Reddy College of Pharmacy, Bengaluru
DIAGNOSIS
From subjective and objective data the patient was found to be diagnosed with:
Hypoglycemia 2° sulfonylura,
Cardiac sarcoidosis
DCMrEF=36
And
T2DM
Acharya & BM Reddy College of Pharmacy, Bengaluru
MEDICATION CHART
Acharya & BM Reddy College of Pharmacy, Bengaluru
ASSESSMENT
TREATMENT GOALS
Relieve or reduce symptoms
To prevent disease progression.
To improve overall health status.
To improve the patient’s quality of life
Prevent or minimize hospitalizations for exacerbations of heart failure
To prevent organ damage and manage co-morbidities
Acharya & BM Reddy College of Pharmacy, Bengaluru
PLAN
DRUG INTERACTION
1. Perindopril + torsemide : perindopril, torsemide. Mechanism: pharmacodynamics synergism. Use
Caution/Monitor. Risk of acute hypotension, renal insufficiency.
2. Perindopril + spironolactone: perindopril, spironolactone. Mechanism: pharmacodynamic
synergism. Use Caution/Monitor. Risk of hyperkalemia.
3. Carvedilol + spironolactone: carvedilol and spironolactone both increase serum potassium.
Modify Therapy/Monitor Closely.
4. Spironolactone + torsemide : spironolactone increases and torsemide decreases serum potassium.
Effect of interaction is not clear, use caution. Modify Therapy/Monitor Closely.
Carvedilol + torsemide : carvedilol increases and torsemide decreases serum potassium. Effect of
interaction is not clear, use caution. Use Caution/Monitor.
Pantoprazole + methotrexate: pantoprazole increases levels of methotrexate by decreasing renal
clearance. Use Caution/Monitor. Increased risk of toxicity with higher doses.
Acharya & BM Reddy College of Pharmacy, Bengaluru
PATIENT EDUCATION
Disease specific:
Diastolic heart failure :a condition in which your heart’s main pumping chamber (left ventricle) becomes stiff and
unable to fill properly.
Symptoms include:
Dyspnea Fatigue
Exercise intolerance Jugular venous distension
Pulmonary rales. Peripheral edema
Coughing or wheezing. Dizziness
Frequent urination
Lifestyle modifications:
Maintaining a healthy weight: Sudden weight gain or loss can indicate heart failure or progression
Eating a healthy diet: A balanced diet with fruits, vegetables, whole grains, lean meats, and fish can help improve heart health
Exercising regularly: Daily light exercise can help manage symptoms
Quitting smoking: Nicotine increases heart rate and blood pressure
Monitoring blood pressure: Hypertension can worsen symptoms
Managing stress
Tracking daily fluid intake
Avoiding or limiting alcohol
Pneumococcal (1st dose after HF diagnosis, 2nd dose after 5 years) and influenza vaccination (yearly before onset of winter) should be encouraged.
Acharya & BM Reddy College of Pharmacy, Bengaluru
Diet specific:
Patient was asked to follow a healthy diet consisting of fruits, vegetables,
whole grain and low in saturated fat.
Patient was advised to limit daily salt intake to 1.5g/day.
Drug specific:
Patient was advised to take adequate rest after taking carvedilol as it can
cause giddiness and fatigue.
In case of any adverse reaction from medication, the patient was advised to
consult doctor immediately.
Patient was advised to always carry inhaler.
Patient was advised to do gargle after inhalation technique.
Acharya & BM Reddy College of Pharmacy, Bengaluru
Side effects
THANK YOU
Acharya & BM Reddy College of Pharmacy, Bengaluru
