A case study on chronic Rheumatic heart disease.pptx

Case Study: In-depth Examination and Comprehensive Analysis of Chronic Rheumatic Heart Disease (CRHD) - Exploring Etiology, Diagnosis, Treatment Strategies, and Patient Outcomes.

1. A Case presentation on known case of Chronic Rheumatic Heart disease P J Hemanth Reddy Pharm. D VI th year 19Y01T0018 CESCOP

2. Rheumatic heart disease (RHD) is a chronic inflammatory condition of the heart, primarily affecting the heart valves, which results from inadequately treated or untreated streptococcal infections, particularly those caused by Streptococcus pyogenes. The inflammatory response triggered by these infections can lead to the scarring and deformation of heart valves, impairing their proper functioning and potentially causing long-term cardiovascular complications, including heart failure. RHEUMATIC HEART DISEASE

3. It is estimated that there are over 15 million cases of RHD worldwide, with 2,82,000 new cases and 2,33,000 deaths annually. In India the prevalence ranges from 5-7 cases per 1000 people in 5-15 age group. RHD constitute 20-30% hospital admission due to CVD Streptococcal infections common in children living in under privileged conditions and RF accounts for 1-3% of cases. EPIDEMIOLOGY

4. Rheumatic heart disease is primarily caused by inadequately treated or untreated streptococcal infections, particularly those resulting from group A Streptococcus bacteria, commonly known as Streptococcus pyogenes . ETIOLOGY

5. PATHOPHYSIOLOGY Causative agent of Group-A β-hemolytic streptococci (From external source) Infection in throat If the streptococci infection in sore throat is untreated Rheumatic fever + Recurrent infections Cross immune response between host and Streptococcal antigens Abnormal reactions - Autoimmune disease Rheumatic pancarditis Fibres thickening and thickened valves Valvular regurgitation and stenosis Heart failure

6. CLINICAL PRESENTATION RHD Fever Palpitations Fatigue Chest pain Syncope Joint pains Oedema Unintended weight loss Shortness of breath (with or without any activity) Heart murmur

7. Physical examination Past medical history ASO Titer Chest X-ray Electrocardiogram (ECG) 2D Echocardiogram DIAGNOSIS

8. There is no permanent cure to the disease, only treating the the underlying symptoms and other complications is preferred. Mostly preferred class of drugs include: Antihypertensive - β blockers, calcium channel blockers. Diuretics Anticoagulants in Atrial fibrillation to prevent stroke MANAGEMENT PHARMACOTHERAPY Non-PHARMACOTHERAPY Surgical treatment is mostly preferred in rheumatic heart disease and the surgical options include the following: Balloon Valvuloplasty Heart valves replacement

9. PATIENT CASE DATA

10. A 36 years old male patient was admitted in male medicine ward - VII with IP No: 21848 under the consultant doctor Dr.Sreenivasulu M.D, with chief complaints of Shortness of Breath on exertion and on lying down since t hree days, Abdominal distension insidious onset with Pedal edema and Jaundice since three days. The patient was already a known case of Chronic Rheumatic Heart disease, diagnosed three years back. His personal History and Habits presented with Alcoholic and Smoker since 15 years, mixed diet, normal appetite, regular bowel and bladder habits, with adequate sleep and he don’t have any significant family history. SOAP NOTES DEMOGRAPHIC DATA SUBJECTIVE EVIDENCE Patient name: xxxxxx Gender: Male Age: 36 years IP.no: 21848 DOA: 15 / 04 /202 4 Department: Male medicine - VII Consultant Doctor: Dr.Sreenivasulu M.D

11. SOAP NOTES OBJECTIVE EVIDENCE Complete blood picture Results Units WBC 4,200 Thousands/Cumm RBC 3.78 millions/Cumm HB 10.2 gm/dl PLT 1.61 lakhs/Cumm Liver function test Total.Br 1.1 mg/dl Direct.Br 0.3 mg/dl SGPT 54 U/L SGOT 93 U/L ALP 94 IU/Lit T.proteins 6.1 gm/dl Sr.Albumin 3.2 gm/dl Renal function test Results Units Blood Urea 21 mg/dl Sr Creatinine 0.7 mg/dl

12. SOAP NOTES OBJECTIVE EVIDENCE 2D Echocardiogram Dilated Left atrium Severe MS, TR, Moderate MR Calcification positive, DML IMP: CRHD Serum Electrolytes Results Units Sodium 140 mg/dl Potassium 3.6 mg/dl Chloride 102 mg/dl ASSESSMENT Based on subjective and objective evidence, the patient was a Known case of CHRONIC RHEUMATIC HEART DISEASE.

13. PLANNING S.No Brand Name Generic Name Indication Dose ROA Frequency Duration 1. Tab. Acitrom Acenocoumarol Anticoagulant 2mg PO OD D1 to D3 2. Inj . Lasix Furosemide Loop Diuretic 20 mg IV BD D1 to D3 3. Tab. Aldactone Spironolactone Diuretic 25mg PO OD D1 toD3 4. Tab. Dilzem Diltiazem Antihypertensive 90mg PO BD D1 toD3 5. Tab . Pantop Pantoprazole Antiulcerants 40mg PO OD D1 to D3 6. Inj. Thiamine Thiamine Vitamin-B1 Supplement 200mg IV OD D1 to D3

14. PROGRESS CHART Prognosis Treatment Day-1 16/04/2024 Patient was conscious and coherent O/E Temp- Afebrile PR - 80 bpm BP- 110/ 7 0 mm /Hg SpO2 - 98% @ RA RS- B/L BAE + P/A- Soft 🔺 Chronic Rheumatic Heart Disease Rx Tab. Acitrom 2mg PO at 4pm daily Inj. Lasix 20 mg IV OD 1-1-0 Tab. Aldactone 25 mg PO OD 1-0-0 Tab. Dilzem 90 mg PO BD 1-0-1 Tab. Pantop 40 mg PO OD 1-0-0 Inj. Thiamine 200 mg in 100ml NS IV OD 1-0-0

15. PROGRESS CHART Prognosis Treatment Day 2 17 / 04 /202 4 Patient was conscious and coherent O/E Temp- Afebrile PR - 80 bpm BP- 120/70 mm/Hg SpO2 - 98% @ RA CVS- S1S2 + RS- B/L BAE + P/A- Soft CNS- NFND Rx Continue same treatment

16. PROGRESS CHART Prognosis Treatment Day 3 1 8 / 04 /202 4 Patient was conscious and coherent O/E Temp- Afebrile PR - 86 bpm BP- 110/90 mm/Hg SpO2 - 98% @ RA PA- Soft RS- B/L BAE + CVS- S1S2 + CNS- NFND Rx Continue same treatment

17. MECHANISM OF ACTION Mechanism of Action ADRs MP Acenocoumarol: It acts by inhibition of vitamin K epoxide reductase, which impairs gamma carboxylation of glutamic acid residues of the precursor proteins of factors II, VII, IX, and X. Hemorrhage INR, prothrombin time Furosemide: Furosemide exhibits diuretic activity primarily through inhibiting the absorption of sodium and chloride in the proximal and distal tubules, as well as in the loop of Henle. Hypotension Loss of electrolytes Serum electrolytes Spironolactone: It inhibits the effect of aldosterone by competing for the aldosterone-dependent sodium-potassium exchange site in the distal tubule cells. Electrolytes imbalance Serum electrolytes

18. MECHANISM OF ACTION Mechanism of Action ADRs MP Diltiazem: Diltiazem is a calcium channel blocker that works by inhibiting the influx of calcium ions into cardiac and smooth muscle cells during depolarization. This action leads to vasodilation, decreased heart rate, and reduced myocardial contractility, which helps to lower blood pressure. Bradycardia, Hypotension, Pedal edema Dizziness, Headache BP, ECG, HR, Pantoprazole : It covalently binds to the H+ K+ ATPase pump at the secretory surface of gastric parietal cells and inhibits the gastric acid and basal acid secretion. Abdominal pain, Diarrhoea, Headache Monitor GI symptoms Thiamine: Is an essential water-soluble vitamin required for cellular energy production in most internal organs, especially in neurons and the heart. Non-allergic anaphylaxis symptomatic improvement, Monitor vitamin levels

19. The given treatment was found to be R ational . PHARMACIST INTERVENTION RATIONALITY DRUG INTERACTIONS No Drug - Drug Interaction found

20. Chronic rheumatic heart disease is a condition where the heart valves get damaged over time due to a previous episode of rheumatic fever, making it harder for the heart to pump blood efficiently. PATIENT COUNSELING REGARDING DISEASES REGARDING DRUGS Tab. Acitrom 2mg should be taken once a day at 4pm and it is used to prevent blood clots. Tab. Aldactone 25mg should be taken once a day and it is used to treat lower limbs edema. Tab. Dilzem 90 mg Should be taken twice a day and it is used to lower blood pressure. Tab. Pantop 40 mg Should be taken Once a day and it is used for gastric irritation.

21. Consistent use of prescribed medications to manage symptoms and complications is really essential. Routine follow-ups with healthcare professionals to monitor the condition, assess treatment effectiveness, and address any emerging issues promptly. Emphasizing fruits, vegetables, whole grains, and lean proteins with low in salt, saturated fats, and cholesterol can benefit overall cardiovascular health. Engaging in regular, moderate exercise as advised by healthcare providers. Practicing stress-reducing techniques, such as mindfulness, meditation, or yoga, can contribute to overall well-being and help manage stress-related factors. Maintaining a healthy weight is essential, as excess weight can strain the heart and worsen symptoms. Maintaining proper hydration is crucial for heart health. Drinking an adequate amount of water helps support overall cardiovascular function and can prevent complications related to dehydration. Prioritizing good sleep is essential. Aim for sufficient quality sleep each night, as adequate rest supports the body's healing processes and overall well-being. PATIENT COUNSELING LIFESTYLE MODIFICATIONS

22. https://www.hopkinsmedicine.org/health/conditions-and-diseases/rheumatic-heart-disease . WWW.micromedexsolutions.com. Standard treatment guidelines by Dr.Sangeeta Sharma, usha gupta ,GR Sethi. 4th edition. Page no:- 45 to 48 https://youtu.be/ivIE8ARRIgM https://chat.openai.com/share/403719b3-0070-4c9f-8bc1-9c830225a355 REFERENCES

23. Thank you P J Hemanth Reddy