SYSTEMIC SCLEROTIC MYOCARDITIS WITH ACUTE GASTROENTERITIS.pdf

Systemic sclerosis with myocarditis, AF with FVR and acute gastroenteritis,
Diagnosis, treatment, patient counseling, 2D Echo, case study

1. SYSTEMICSCLEROTIC
MYOCARDITIS
WITH ACUTE GASTROENTERITIS
AND AF WITH FVR
V. GANAPATHI
19353D1009
PHARM. D VI YEAR
JAYAMUKHI COLLEGE OF PHARMACY
GANAPATHIGREAT369

2. SUBJECTIVE FINDINGS
A female patient of age 28 years presented to the hospital with C/o:
❑Multiple episodes of vomiting and loose stools since 2days
❑Abdominal pain, asthenia and anorexia+
❑SOB (NYHA Gr- III) since today morning
K/C/O:
❑systemic sclerosis
❑h/o: B/L- UL Finger tips gangrene (6 months back)
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3. OBJECTIVE FINDINGS
S.N VITALS INITIAL DAY-1 DAY-2
1 ON EXAMINATION C/C/C C/C/C C/C/C
2 PULSE RATE (bpm) 98 121 78
3 B.P. (mmHg) 140/100 150/107 152/94
4 SpO2 (%) 95% with 4L O2 100% with NIV 100% with 2L O2
5 TEMPERATURE (*F) Afebrile Afebrile Afebrile
6 LUNGS B/L Crepts+ B/L Crepts+ Basal Crepts+↓
7 PARA ABDOMEN Diffuse tenderness+Diffuse tender+Soft, BS -sluggish
8 HEART S1 S2+ S1 S2+ S1 S2+
9 GCS SCORE (15) E4V5M6 E4VTM6 E4V5M6
•NOTE: B.P- Blood Pressure, C/C/C- conscious/ coherent/ cooperative, SpO2- saturation of peripheral
oxygen, GRBS- general random blood sugar and RA- room air.
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4. LAB INVESTIGATIONS
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S.N PARAMETER NORMAL RANGE RESULTS
1 Haemoglobin (gm) 13-17 9.2
2 RBC Count (M/cumm) 4.5-5.5 3.54
3 WBC Count (C/cumm) 4000-11000 7,900
4 Platelet Count (L/cumm) 1.5-4.5 2.59
5 Urea (mg/dl) 20-40 22
6 Serum Creatinine (mg/dl) 0.7-1.2 0.9
7 Serum Sodium (mmol/L) 136-145 148
8 Serum Potassium (mmol/L) 3.6-5.1 3.7
9 Serum Chloride (mmol/L) 98-108 108
10 Uric Acid (mg/dl) 2.6-6.8 6.8
NOTE: M/cumm- million/cubic millimeter, C/cumm- cells/cubic millimeter, gm- gram, L/cumm- lakh/
cubic millimeter, mg/dl- milligram/ deciliter and mmol/L- millimole/litre.

5. LAB INVESTIGATIONS
GANAPATHIGREAT369
S.N PARAMETER NORMAL RANGE RESULTS
11 NT pro BNP (pg/ml) <900 2919
12 TROPONIN-I (ng/ml) 0.034 3.5
13 Serum Amylase (U/L) 40-140 48.5
14 Serum Lipase (U/L) 10-140 14.7
15 Serum SGOT (IU/L) 8-45 18
16 Serum SGPT (IU/L) 7-56 20
17 Pus Cells in Urine (HPF) 0-5 2-4
18 Epithelial Cells in Urine (HPF) 15-25 Plenty
19 Arterial PH 7.3-7.5 7.3
20 PCO2 (mmHg) 35-45 32
21 HCO3 (mmHg) 22-28 19.19
22 PO2 (meq/L) 75-100 53

6. IMAGING FINDINGS
CT THORAX (P):
oDense non homogenous consolidation are seen in peri bronchial and
perihilar distribution of B/L lung fields with adjacent interlobar &
peri bronchial interstitial thickening
opossibly resolving pneumonia/ ARDS needs to be considered.
CT ABDOMEN & PELVIS:
oAcute B/L renal parenchymal changes noted
oDiffusely edematous ileal loops are seen with maximum thickness of
8mm ---possibly enteritis.
oFluid distended large bowel loops are seen
oMild ascites is noted
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7. OTHER FINDINGS
2D ECHO:
❑MVP with Moderate MR
❑AML prolongation, No LV RWMA
❑Good LV function, EF-55%
❑Grade- I DD, IVC collapsing
PERIPHERAL SMEAR:
❑RBC: Anisopoikilocytosis sharing macrocytes, microlytic
hypochromic, RBC with tear drop & pencil shaped
❑WBC: Normal morphology & distribution of cells seen
❑Platelets: Adequate.
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8. ASSESSMENT
❑On the basis of subjective, objective and imaging
finding confirms that the patient has been
diagnosed with-
Systemic Sclerotic Myocarditis with Acute
Gastroenteritis and AF with FVR
❑K/C/O: SSC, H/O- B/L- UL Finger tips gangrene
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9. PHARMACOLOGICAL THERAPY
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S.N BRAND DRUG DOSE R.O.AFREQUENCY DURATION
1 REDABACT CEFOPERAZONE&
SULBACTAM
1000/500M
G
IV TWICE D1-D7
2 METROGYL METRONIDAZOLE 500MG IV THRICE D1-D7
3 CLEXANE ENOXAPARINE 60MG IV ONCE D1-D7
4 LASIX FUROSEMIDE MG PO TWICE D1-D7
5 ECOSPRINE-
AV
ASPIRIN &
ATORVASTATIN
75/20MG PO ONCE D1-D7
6 MPS METHYL
PREDNISOLONE
500MG IV ONCE D1-D7
7 PAN PANTOPRAZOLE 40MG PO ONCE D1-D7
8 OXRA DAPAGLIFLOZIN 10MG PO ONCE D1-D7
9ALDACTONE SPIRONOLACTONE 25MG PO ONCE D1-D7

10. PHARMACOLOGICAL THERAPY
GANAPATHIGREAT369
S.N BRAND DRUG DOSE R.O.AFREQUENCY DURATION
10 ZOFER ONDANSETRON 4MG IV THRICE D1-D2
11 REDOTIL RACECADOTRIL 100MG PO TWICE D1-D2
12 DAROLAC LACTOBACILLUS 2.5 B.C PO TRICE D1-D3
13NEB’S WITH
DUOLIN
LEVOSALBUTAMOL &
IPRATROPIUM
1.25/500MG PN THRICE D1-D5
14NEB’S WITH
BUDECORT
BUDESONIDE 0.5MG PN THRICE D1-D5
15 NEOMOL ACETAMINOPHEN 500MG IV SOS SOS

11. PATIENT EDUCATION
GANAPATHIGREAT369
❖Take medication as advised by the doctor regularly
❖Don’t scratch and rub the skin with force
❖Eat fresh fruits and vegetables
❖Avoid direct contact with pet animals and contaminated things
❖Regular bath with moderate hot water
❖Seek immediate medical care in case of any unwanted side effects
❖Regular physical exercise and walking

12. EVERY END HAS A NEW
BEGINING
[email protected]
GANAPATHIGREAT369