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.