Case Study
Section: 1
1. Case Study
Student Name: Dewan Sayed Al Sahriar Reza
Student ID:2135182672
 Greg George, a 70 years - old African- American patient has heart failure and diabetes . His vital signs are blood
pressure 176/94, pulse 92, and respirations 30 . His medications include hydrochlorothiazide 50mg/day, atenolol
50mg/day and diagoxin 0.25 mg/day.
 What is congestive heart failure?
 Why hydrochlorothiazide was prescribed for Mr. George?
 What effect may result when Mr. George takes diagoxin and hydrochlorothiazide together?
 Would atenolol be effective in lowering Mr. George BP if given as the only antihypertensive drug?
 How effective is the combination of hydrochlorothiazide and atenolol for controlling Mr. George Blood pressure?
Explain your answer.
 When using a combination of drug therapy to correct hypertension, would the dosage for each drug be the same?
Jahidul Islam Rifat
ID: 2135164672
2. Case Study
HPI: Jenny, a 52-year-old woman, presents to your office, complaining of 3 days of increasing shortness of
breath. Her dyspnea is worse with exercise and relieved somewhat by rest. She has had to prop herself up in
bed to avoid feeling like she’s “drowning.” She also complains of swelling in both ankles. She has also
developed a cough productive of pinkish-colored sputum.
PMI: She denies alcohol use and gave up smoking after her heart attack last year. Before that, she smoked a
pack daily for over 30 years. She denies having a significant cough. She is on a “water pill” but does not
always take it. She takes a “baby aspirin” daily.
P/E: Jenny is an obese female in moderate respiratory distress. Vitals: HR 112; RR 24; BP 150/90; Temp 37°C
98.6°; SpO2 7% on room air. A head and neck exam reveals an elevated JVP and thready coronary artery
pulses. Her apex beat is enlarged and displaced downward and laterally. A fourth heart sound is present and
crackles are heard in her lung bases bilaterally. Her liver edge is palpable 10 cm below the costal margin. Her
peripheral pulses are weak, and her capillary refill is delayed.
Questions:
1. What is the most likely diagnosis?
2. What in her history likely led to her current condition?
3. Why might you choose digoxin to treat this patient?
4. How might angiotensin-converting enzyme inhibitor (ACE-I) drugs help this patient?
3. Case Study
Name:Sumaya Hossain
Id:2235406672
A 52 year old woman comes to primary care clinic with chief complain of epigastric pain.She has no pain
currently.She first noticed the pain 2 months ago.She describes the pain as burning sensation in the middle of the
upper stomach that radiates to her mid upper back.It seems to come only with exertion and not at rest.The pain
usually lasts 10-15 minutes and goes away if she takes break.
Medical History : Hypertension
Medication: Lisinopril,Omeprazole
Family History:Father had myocardial infarction (MI) at the age of 43.Mother has hypertension.
Vital Signs: Temarature 98.7,Pulse:76,BP:162/86
Question
1.What is the diagnosis of the disease?Mention the diagnosis procedures for this disease.
2.What are the risk factors for this disease?
3.What type of medicine and therapies should be given to the patient?
4. Case Study
MD Rokon Uddin
Id: 2215157072
19. Mr AG, a 57-year-old taxi driver of Indian origin, attends your community pharmacy with a new prescription for: glyceryl
trinitrate (GTN) spray 400 micro- grams – one or two puffs as required. You dispense this item and speak with him, and he tells
you that his GP thinks he has angina and has asked him to use the spray the next time he gets any minor chest pain or tightness.
You counsel Mr AG on the correct use of the spray. Mr AG returns a few days later complaining of a headache following the use
of the spray. He is reluctant to use the spray again. He asks your advice on managing his headache. He also smokes about five
cigarettes a week and asks if he should now stop.
Questions
1a. What is angina?
1b. What typical symptoms could a patient with angina present with?
2a. What are the risk factors for developing angina?
2b. What, if any, risk factors do Mr AG have for developing stable angina?
3a. What group of drugs does GTN spray belong to?
3b. What are the side-effects of GTN spray?
3c. How would you counsel Mr AG on the use of his spray?
3d. What other formulations of GTN are available? List their advantages and disadvantages.
4. Mr AG’s headache may be caused by his use of GTN spray. What can you recommend to him to help manage his headache?
5. What advice would you give Mr AG in relation to his smoking?
5. Case Study
Faysal Ahmed
ID: 2235393672
L.N. is a 49-year-old white woman with a history of type 2 diabetes, obesity, hypertension, and migraine
headaches. The patient was diagnosed with type 2 diabetes 9 years ago when she presented with mild polyuria
and polydipsia. Initial treatment for her diabetes consisted of an oral sulfonylurea with the rapid addition of
metformin. Her diabetes has been under fair control with a most recent hemoglobin A1c of 7.4%. Hypertension was
diagnosed 5 years ago when blood pressure (BP) consistently elevated in the range of 160/90 mmHg on three
occasions. L.N. was initially treated with Lisinopril, starting at 10 mg daily and increasing to 20 mg daily, yet her BP
control has fluctuated. One year ago, microalbuminuria was detected on an annual urine screen, with 1,943 mg/dl
of microalbumin identified on a spot urine sample. Physical examination reveals an obese woman with a BP of
154/86 mmHg and a pulse of 78 bpm.
Questions
1. What are the effects of controlling BP in people with diabetes?
2. Which antihypertensive agents are recommended for patients with diabetes?
3. Which antihypertensive should be given to a patient who is suffering from kidney disease?
6. Case Study
Faria Ahmed Oyshee
Std.ID: 2135112072
Primary hypertension has been diagnosed in Ms. G., a 47-year-old woman. Blood pressure readings have been ranging
between 158 and 172 mm Hg systolic and 94 and 110 mm Hg diastolic. Average blood pressure over the past month has been
156/96 mm Hg. There is a strong family history of hypertension. Ms. G. is a single parent of two adolescents. She is also trying
to keep up with her responsibilities as a full-time assistant professor of education at a local urban university and works more
than 40 hours a week. There is no evidence of renal insufficiency or cardiac damage at this time, nor is there evidence of
retinopathy or other signs and symptoms of the end-organ disease. No other problems are reported. Ms. G. is started on 50
mg of hydrochlorothiazide daily with a small dose of the B-blocker atenolol.
I.
Discuss the side effects of hydrochlorothiazide & Beta blockers.
II.
Will the suggested drug be suitable for that particular patient? Why?
III.
Why does primary hypertension occur?
IV.
What sort of consequences she might face for her hypertension?
V.
What other non-pharmacologic measures should you tell the patient about that can help her control her blood
pressure?
VI.
What other laboratory test can she perform to know about the details of her hypertension?
7. Case Study
Tazore Hossen Mahin
ID. 2215339672
65‐year‐old woman (NKDA) who has no history of coronary heart disease. He is non‐smoker but drinks 1 glass wine
at dinner. Family history: Father died of MI at age 45. Physical Exam: BP = 120/82, HR = 70, weight = 162
pounds
Current medication: (Penicillin allergy) L‐thyroxine 0.05 mg po daily, lisinopril 10 mg po daily
Lab Test: Fasting Lipid Profile (after 6 months of diet therapy)
 Total cholesterol 260 mg/dl
 Triglycerides 175 mg/dl
 HDL‐C 38 mg/dl and LDL‐C 193 mg/dl
 Fasting Blood Glucose 89 mg/dl
 ALT 30 (0‐34 U/L)
 AST 24 (7‐42 U/L)
 TSH 6.0 (0.4‐4.8 mIU/ml)
Questions
A. What is the suspected disease patient may be suffering from?
B. Write the medications that may be suggested for patients?
C. If the patient is dyslipidemic ,what is futher progressive disease that may occur in future? And how will you counsel
her ?
8.Case study
Ramisa Tasnim ID: 2215051672
A 55-year-old Caucasian man presented with polyuria, polydipsia, and "feeling dry" during
the past2 months. His medical history was remarkable for a 3-year history of
poorly controlled hypertriglyceridemia. His initial fasting serum cholesterol was 299
mg/dl, triglycerides were 928mg/dl, and high-density lipoprotein (HDL) cholesterol was
30 mg/dl before treatment. He was treated with gemfibrozil 600 mg twice daily and told
to watch his diet and exercise. Noreferral was made to a registered dietitian. Two years
later, a fasting triglyceride level of 570 mg/dl prompted further increase of gemfibrozil
to600 mg three times daily (this exceeds usual recommended dosing). The patient
took no other medications and denied drinking alcohol and smoking. Laboratory
evaluation showed serum glucoseof 397 mg/dl. Urinalysis revealed 3+ glucose and
negative ketones.
Questions
1. What is a normal level of serum triglyerides?
2. What is the medical nutrition therapy for hypertriglyeridemia?
3. What are current recommendations for screening for diabetes?
4. What effect did the onset of diabetes have on this patient's hypertriglyceridemia?
9. Case study
Name: Sakib Mahbub ID:2215170
Sec: 1
A 74-year-old woman presents for her annual physical examination and notes increasing fatigue over the
prior 3 months. Her history is notable for longstanding, but now well-controlled, systolic hypertension. A
physical examination demonstrates a blood pressure of 120/70 mm Hg and an irregular pulse of
approximately 120 bpm at rest. The patient weighs 130 pounds with a body mass index of 22. An
electrocardiogram confirms the diagnosis of atrial fibrillation with a ventricular response of 120 bpm and
voltage criteria for left ventricular hypertrophy. An echocardiogram done a year earlier to evaluate left
ventricular hypertrophy was notable only for mild, global left ventricular dysfunction with a left ventricular
ejection fraction of 40%. A subsequent exercise echocardiogram showed no evidence of myocardial
ischemia.
Clinical Questions
 What medications should be chosen to control the rate acutely?
 What further work up is required for new onset AF?
 Should one restore sinus rhythm or choose a strategy of rate control?
 What are the anticoagulation requirements for this patient?
10. Case Study
Fatema Omar
ID-2235373672
A 60-year-old man entered the emergency department after 2 days of "not feeling so well." He had difficulty in
breathing and irregular heart palpitations. History revealed a myocardial infarction 5 years ago, when he was prescribed
digoxin. Two years ago, he was prescribed a diuretic after periodic bouts of edema. An ECG at time of admission was
done to diagnose the disease.
Admitting lab results are shown LABORATORY RESULTS
VENOUS BLOOD
Digoxin: 1.4 ng/mL,
therapeutic 0.5-2.2 (1.8 nmol/L, therapeutic 0.6-2.8),
HCO3: 25 mmol/L
Mg2+: 0.4 mmol/L,
Na+: 137 mmol/L,
K+: 2.5 mmol/L,
Cl-: 100 mmol/L,
lon/freeCa2+: 1.0 mmol/L
Questions
1. Because the digoxin level is within the therapeutic range, what may be the cause for the arrhythmia?
2. What is the most likely cause for the hypomagnesemia?
3. What is most likely the cause for the decreased potassium and ionisedcalcium levels?
4.What are the signs and symptoms of Cardiac Arrhythmia?
5. What type of treatment would be helpful?
11. Case Study
Name: Bibi Marium Student ID: 2235429672
Mr. Smith is a 58-year-old male with a history of hypertension and smoking. He presents to the emergency
department with severe chest pain that started about an hour ago. The pain is radiating to his left arm and jaw,
and he also complains of shortness of breath and sweating. He appears pale and is diaphoretic.
Questions:
Q1: What is the likely diagnosis for Mr. Smith?
Q2: What are the risk factors for myocardial infarction?
Q3: What are the typical symptoms of myocardial infarction?
Q4: What diagnostic tests should be performed to confirm the diagnosis?
24. Case Study
Nusrat Kamal Mim
ID: 2235197672
48 year old Jason Dixon had not been feeling well all day and around 10:00 p.m he
went to bed. At around 4:00 a.m. his wife awakened to see him slump to the floor,
breathing with difficulty and drenched in perspiration. Alarmed when he told her of
the pain in his chest, neck and arm, she called 911. Within 12 minutes, emergency
response team personnel (EMTs) were on the scene. During this critical period, EMT
personnel performed the standard emergency treatment protocol for a patient with
symptoms of a myocardial infarction, commonly referred to as a heart attack.
1. What symptoms did Jason exhibit?
2. If you were an emergency medical technician treating a suspected myocardial
infarction (heart attack), what would you do for initial assessment of the patient?
3. What initial treatment would you give the patient?
4. Summarize the lifestyle risks of the patient
13. Case Study
Name : Amana Akter
ID : 2235434672
patient returns 1 week later with results from her fasting blood work. The provider also requests an FBG, A1c, and vitals
at today’s visit. Results are listed below.
VS: BP 138/78 mm Hg, P 76 beats/min, RR 17 breaths/min,
T 36.8°C (98.2°F)
A1c (today): 7.9% (0.079; 63 mmol/mol Hgb)
FPG (today): 178 mg/dL (9.9 mmol/L)
Labs (2 days ago): Na 135 mEq/L (mmol/L); K 4.0 mEq/L (mmol/L); Cl 98 mEq/L (mmol/L); CO2 24 mEq/L (mmol/L);
blood urea nitrogen (BUN) 15 mg/dL (5.4 mmol/L);
SCr 0.8 mg/dL (71 μmol/L); BG 186 mg/dL (10.3 mmol/L)
The patient is diagnosed with T2DM.
a.
b.
c.
d.
e.
Identify the goals of treatment for this patient.
What nonpharmacologic alternatives are available for this patient for her diabetes?
What are the three general categories of pharmacologic alternatives used to lower blood glucose?
What is the most appropriate initial therapy for this patient in regard to her diabetes?
What additional interventions are recommended for this patient today?
14. Case Study
Tanmay Kumar Ray
ID: 2235436672
A 24 year old healthy, slender woman is referred because she has a family history of premature CAD (mother, age
59, had onset of angina at 53). Patient’s diet and exercise habits are exemplary.
Her lipid panel reveals the following:
–Total cholesterol 236
–Triglycerides 120
–HDL-C 52
–LDL-C 160
Thyroid and liver function tests are normal
Physical exam is normal
• What additional information would you like to have about her mother?
• What other lab tests would you order?
• Would a measure of arterial stiffness (baPWV) be useful in risk assessment of this patient?
• What diagnosis would you consider if she had no family history of premature CVD and her parents’
lipids were normal?
Case Studies
Section 2
1. Hridoy Chandra Ghosh (2315066 672)
Case Study: Hypertension
Mr. Aru is a 45-year-old accountant who was admitted 2 days ago to hospital following a blackout whilst watching a
football match with his wife. His preliminary examination reveals bruising to his left arm and upper thigh for which
he has been prescribed paracetamol 1gm four times daily and as required ibuprofen 400 mg three times a day. His
past medical history indicates that he is on no medication and seemed to be a reasonably fit man for his age with no
existing diagnosed medical conditions. On examination he is slightly overweight at 81 kg, he smokes 20 cigarettes
per day and drinks approximately 30 units of alcohol per week. His blood pressure on admission was 165/90 mmHg
with a heart rate of 90 beats per minute. This degree of raised blood pressure and heart rate has been maintained
over the last 48 hours.
He is subsequently diagnosed as having hypertension.
1. How would you assess this patient’s cardiovascular risks? What are the appropriate treatment targets for this
patient’s blood pressure?
2. Besides blood pressure, what other advice and treatment does this patient require to ensure his risk of a
cardiovascular event is reduced? Give clear reasons for your advice and explain the risks associated with not taking
this advice.
3. What are the main classes of drug used to treat hypertension? Mention the appropriate first-line treatment for
Mr. Aru with proper starting dose, frequency, contraindications and several side effects.
4. How would this treatment choice be affected if the patient had been of Afro-Caribbean origin?
2. Fatemeh Bakhtiary 2315072672
Chronic Heart Failure
Mr HS, 72 years old, is admitted to hospital with increasing shortness of breath at rest. He has a previous medical
history of severe left ventricular systolic dysfunction, confirmed by echocardiography, and angina. Before admission
he had been taking the following medication: lisinopril 10 mg daily, furosemide 80 mg each morning and 40 mg at 2
pm, digoxin 62.5 µcg each morning, ISMN SR 60 mg daily, glyceryl trinitrate spray 1–2 doses as required, aspirin 75
mg dispersible each morning. His chest X-ray shows severe pulmonary oedema, his blood pressure is 110/70 mmHg
and serum urea and electrolytes are within normal range. During the admission, carvedilol 3.125 mg twice daily is
started.
Questions
1. What therapeutic options would you choose to treat the acute symptoms presented by Mr HS at the beginning of
his admission?
2. Was the addition of bisoprolol appropriate for this patient?
3. What other drug treatment options might be considered for this patient in the longer term?
3. Salma Anika Sifat (2215247672)
Stable Angina
A 58-year-old male with stable angina pectoris CCS class II presents with hypertension, type 2 diabetes mellitus,
dyslipidemia, and normal kidney function (BP 154/88 mmHg, HbA1C 7.8%, TC 182 mg/dl, LDL-C 108 mg/dl, HDL-C
28 mg/dl, triglycerides 324 mg/dl, and serum creatinine 0.9 mg/dl). He denies family history of premature
cardiovascular disease. He is physically active, vegetarian, non-smoker, self-reported moderate drinker and
overweight (BMI 27.0). He has been receiving aspirin 75 mg a day, telmisartan 40 mg/d, metoprolol succinate 100
mg/d, atorvastatin 20 mg/d, metformin 1.000 mg twice a day, and sitagliptin 100 mg/d. He has no known drug
allergy and did not have any surgical operation in past. Physical examination is unremarkable except firm, palpable
liver 2% fingers below costal margin.
Questions:
1. Do we need to improve his lipid profile? If yes, what improvement is needed?
2. What Measures need to be considered for Improvement in Lipid Profile of this
Patient?
3. Will Change to a Different Beta Blocker (BB) Help?
4. Will Increasing the Dose of Atorvastatin Improve Lipid Profile?
5. How will you further manage dyslipidemia in this Patient?
4. Saima Akhter (2135155072)
Hypertension
Mary is 38 years old. She is attending for a routine appointment about her contraception, for which she uses a
diaphragm.
Medical history
From her records you notice that Mary’s blood pressure has increased since her last check twelve months ago. She does
not smoke, drinks 10-12 units of alcohol a week and has no notable medical history. On examination Mary’s first clinic
blood pressure measurement is 158/94 mmHg. Her heart rate is 72 beats per minute and regular
Please note: when using automated devices to measure blood pressure, palpate the radial or brachial pulse before
measuring blood pressure. If pulse irregularity is present, measure blood pressure manually using direct auscultation over
the brachial artery.
You are considering a diagnosis of hypertension and therefore take another reading in Mary’s other arm. There is
nonotable difference between readings.
Question 1. What would you do next?
Question 2. You identify her dietary sodium intake is greater than recommended levels. What advice would you offer?
Question 3. The result of Mary’s ABPM shows daytime average blood pressure of 145/92 mmHg. What would your
diagnosis and your next steps be?
Question 4. If Mary had been eligible to receive antihypertensive drug treatment, what should you consider when
prescribing antihypertensive drugs for a woman of child-bearing potential?
5. Mst. Rabeya khatun ID: 21254866072
Hypertension
Case Study
A 52 years old female Banker visited to Hospital at Dhaka with the complaints of headache, drowsiness, blurred vision,
and palpitation. She was experiencing those symptoms last 2 months.
She was also suffering from diabetes mellitus type 2 since 2 years. She had recently diagnosed with hypertension
(180/105 mmHg)
a) How will you investigate the patient?
b) Why is it important to treat hypertension?
c) How should the patient be treated? (Mention both medication therapy and non-drug
therapy)
d) What target organs are damaged in hypertension?
6. Tanjum Jahan Mojumder (2315356672)
Myocardial Infarction
Mr. Thomas Heart works as a builder. He is an African American man in his mid-fifties who smokes 20 cigarettes a day and
has a history of insulin dependent diabetes type II, hypertension, and atherosclerotic peripheral vascular disease. Heart
was seen at a remote hospital just after his son’s basketball game, around 30 minutes prior, complaining of chest pain and
lack of breath. He was unwilling to go to the clinic at first, but his kids persuaded him to go after learning that he had
been experiencing chest pain and shortness of breath more frequently throughout the previous week.
Vital signs at admission:
BP 190/94; HR 106; O2: 88%; T: 36.7.
Diagnostic information
Test results: LDH 680 U/L, CK-MB 5.8%, and Troponin I 5.3 mg/L.
1. What are very early signs and can be the silent symptoms?
2. What orders are you anticipating? Then why?
3. What kind of care should you expect in the future? Why?
4. What details would you make sure to cover in your patient instruction?
7. Samira Setu
Hypertension
Mr PT, a 35-year-old man, is overweight and has a blood pressure of 178/114 mmHg. He smokes 25 cigarettes daily and
drinks 28 units of alcohol per week. He has a sedentary occupation. He eats excessive quantities of saturated fat and salt.
Question:
1. How should this patient be managed?
2. What pharmacological treatment for blood pressure would be appropriate if non-pharmacological treatment was
unsuccessful?
Mr. PT subsequently stopped smoking and lost some weight but remained hypertensive. He was treated with atenolol 50
mg daily.
His blood pressure fell to 136/84 mmHg but he developed tiredness and bradycardia and complained of erectile
impotence.
3. What are the treatment options for Mr PT?
8. Sabrina Mehzabin
Hyperlipidaemia
Mr. JS is a 50 year old man with a blood pressure of 140/85 mmHg and type 2 diabetes, but no history of coronary heart
disease. He smokes 10 cigarettes a day. On a routine clinic visit he is found to have a TC of 6.4 mmol/l, HDL-C 0.8 mmol/l
and triglycerides 2 mmol/l
Questions:
1. Is PT at high risk of CHD?
2. What advice and/or treatment would be appropriate?
9. Sabiha Farin
CHD
A 57 year-old male lorry driver, presented to his local emergency department with a 20-minute episode of diaphoresis
and chest pain. The chest pain was central, radiating to the left arm and crushing in nature. The pain settled promptly
following 300 mg aspirin orally and 800 mcg glyceryl trinitrate (GTN) spray sublingually administered by paramedics in the
community. He smoked 20 cigarettes daily (38 pack years) but was not aware of any other cardiovascular risk factors. On
examination he appeared comfortable and was able to complete sentences fully. There were no heart murmurs present
on cardiac auscultation. Blood pressure was 180/105 mmHg, heart rate was 83 bpm and regular, oxygen saturation was
97%.
1. What is the most likely diagnosis?
2. How would you manage the patient? (The patient has already received 300 mg aspirin).
10. Tasneem Sultana 2315013672
Heart Failure
Mr. Jones, a 69-year old male, presents to the Emergency Department (ED) after visiting his primary physician
complaining of general fatigue for 4 days, shortness of breath, and abdominal discomfort. Mr. Jones’s medical history
includes hypertension and coronary artery disease. He had a previous 90% LAD blockage and 50% RCA blockage with
stent placements in both.
1. What initial nursing assessments need to be performed for Mr. Jones?
2. What diagnostic tests do you anticipate being ordered by the provider?
Upon further assessment, the patient has crackles bilaterally and tachycardia. A chest X-ray shows cardiomegaly and bilateral pulmonary
edema. An ECG revealed atrial fibrillation. His vital signs were as follows:
• BP 150/72 mmHg Urine Yellow and Cloudy
• HR 102-123 bpm and irregular BUN 17 mg/dL
• RR 24-32 bpm Cr 1.2 mg/dL
• Temp 37.3°C H/H 11.8 g/dL / 36.2%
• Ht 175 cm LDH 705 U/L
• Wt 79 kg ** BNP 843 pg/mL
Mr. Jones was admitted to the cardiac telemetry unit. He states that this weight is approximately 3 kg more than it was 3 days ago.
3. What is the signficance of Mr. Jones' weight gain?
4. What medications do you anticipate the provider ordering for Mr. Jones? Why?
11. MD Nahid Hasan 2235396672
Case Study: Hypertension
Patient Information: Name: John Smith Age: 52 years Gender: Male Occupation: Office worker Medical History: No known
medical conditions Lifestyle: Sedentary lifestyle, unhealthy diet, occasional alcohol consumption, non-smoker
Chief Complaint: John Smith visits his primary care physician with complaints of recurring headaches and dizziness for the
past few weeks. He also mentions feeling fatigued and experiencing occasional chest discomfort.
Clinical Presentation: During the physical examination, John's blood pressure is measured to be consistently high. On three
separate visits, his blood pressure readings are recorded as follows:
1. Visit 1: 160/95 mmHg
2. Visit 2: 158/94 mmHg
3. Visit 3: 162/96 mmHg
Additional Diagnostic Tests:
1. Blood tests: Routine blood tests show no significant abnormalities.
2. Electrocardiogram (ECG): Shows no signs of acute cardiac events or arrhythmias.
3. Echocardiogram: Normal cardiac structure and function.
Questions:
1.
2.
3.
4.
5.
What is the most likely diagnosis for John Smith?
What are the risk factors associated with this condition?
What are the potential complications of this condition?
What lifestyle modifications can be recommended to manage this condition?
What pharmacological treatment options are available for this condition?
Case Study 12: Myocardial Infarction
• Submitted By: Md. Hasib Khan
ID : 2235443672
Section: 02
• John Smith, a 58-year-old male. He has been suffring from Hypertension, Type 2 diabetes, Hyperlipidemia.
Also have smoking habit, Sedentary lifestyle and Family history of cardiovascular disease. Currently he
presents to the emergency department complaining of sudden onset chest pain. He describes the pain as a
squeezing sensation in the center of his chest, radiating down his left arm. The pain has been persistent for
the past 30 minutes. He also reports feeling short of breath, nauseous, and sweaty. On physical examination,
his blood pressure is 160/90 mmHg, heart rate is 110 beats per minute, and he appears pale and diaphoretic.
An electrocardiogram (ECG) is performed immediately, revealing ST-segment elevation in leads II, III, and
aVF.
• 1. Based on the clinical presentation and ECG findings, what is the likely diagnosis for John Smith?
• 2.What are the risk factors associated with myocardial infarction?
3. What are the immediate treatment priorities for John Smith?
4. How can lifestyle modifications help in the prevention of future myocardial infarctions?
• Case Study 13 : Md. Alamgir Hossain
ID:2315305672
Mr. MK, a 55-year-old man is a salesman, weight 98kg, having history of hypertension and type 2 diabetes mellitus for
past 10 years with non-compliance to medication and poor diet control referred to the clinic for further management of
poorly controlled diabetes and hypertension. His blood pressure is 160/90mmHg with pulse rate 88/min and has minimal
bilateral leg edema and bilateral proliferative retinopathy.
• Family history:
Mother: Diabetic (on dialysis)
Father: Stroke (residual left hemiparesis)
• Investigation result:
A1c: 9.2%
FBS: 11.8mmol/L
Serum creatinine: 1.2mg/dL
GFR: 88ml/min1.73m2
24hr urinary protein: 200mg/24hr
ECG: Left ventricular hypertrophy
Past medication:
Metformin: 1000mg BD
Gliclazide: 160mg BD
Amlodipine: 10mg OD
Questions:
1. What might be reasons for his poorly controlled diabetes and hypertension?
2. How do you manage both hypertension and diabetes mellitus?
3. Is there any drug interaction that should be taken in consider?
4. What would be A1c and BP target?
5. What are the major patient counseling points?