PHARMACOLOGICAL AND INTERDISCIPLINARY THERAPEUTIC APPROACH OF A PATIENT WITH CARDIAC DISEASE, SEPSIS AND CHRONIC KIDNEY DISEASE

• Published in: Research and science today no. 2; pp. 205 - 212
• Main Authors: Diaconu, Magdalena, Popa, Romeo, Stanescu, Ligia, Guta, Natalia, Georgescu, Cristian, Tantu, Marinela Monica
• Format: Journal Article
• Language: English
• Published: Targu-Jiu University Constantin Brancusi of Târgu-Jiu 01.10.2020
• Subjects: Abdomen; Acidosis; Angiotensin II; Angiotensin-converting enzyme inhibitors; Antecedents; Antibiotics; Anticoagulants; Atria; Atrium; Beta blockers; Bladder; Blood pressure; Cardiology; Complications; Congestive heart failure; Coronary artery disease; Coronary vessels; Creatinine; Diabetes; Diabetes mellitus; Diabetes mellitus (non-insulin dependent); Diarrhea; Disease; Disorders; Diuretics; Drug therapy; Dyspnea; Edema; Effusion; Embolism; Emergency medical care; Enzyme inhibitors; Enzymes; Etiology; Heart failure; Hemodialysis; Hypertension; Intensive care; Intestine; Kidney diseases; Kidneys; Metabolic acidosis; Metabolism; Myocardial infarction; Myocardium; Nitrates; Pain; Pathology; Patients; Peptidyl-dipeptidase A; Platelets; Potassium; Pulmonary arteries; Renal failure; Sepsis; Ventricle
• ISSN: 2247-4455; 2285-9632

In addition to this pathology are other cardiac pathologies, associations that generate complications and increase the patient's risk of life, and sepsis can trigger either acute renal failure or acute exacerbation of chronic kidney disease: after MI (myocardial infarction) may occur LV (left ventricular) dysfunction, embolism and pericarditis, arrhythmias, mitral regurgitation, recurrent; mild to moderate K (potassium) growth may cause electrocardiographic changes with T waves increasing in amplitude. The clinical examination reveals the general altered state of the patient, with sweaty pale skin, bilateral bladder murmur and sub-repeating rales disseminated in both lung areas, BP = 115/70mmHg, AV = 90 beats/minute, creatinine clearance = 25.7 ml/min, lower limb oedema, with diagnosis: ACPO (acute cardiogenic pulmonary oedema), HF (heart failure) class IV NYHA, low ejection fraction, primary HBP (high blood pressure), grade 3, very high cumulative risk, old myocardium infarction, moderate mitral insufficiency, paroxysmal AFib in the background, pericardial effusion, stage 5 CKD, type 2 diabetes, anaemic syndrome, left small quantity pleurisy, metabolic acidosis. Detailed history describes a relatively complex background medication: beta-blocker, anticoagulant, platelet antiaggregant, loop diuretic, angiotensin II receptor antagonist, antiguts, nitrates in pain, highlights a series of personal pathological antecedents, with etiological importance for the present status, namely that the patient also had accelerated intestinal transit, with multiple diarrhoea stools, and to detect a contagious disease that may have adverse repercussions on the patient, but also on other patients, it was decided to perform the rapid test for Clostridium difficile, the result being negative, but also a history of diabetes. RA = right atrium; IVC= inferior vena cava; TDE = time of detection of wave E. The treatment, used in the Cardiology Clinic, consisted of anticoagulant, platelet antiaggregant, antiarrhythmic, nitrate, beta-blocker, thiazide diuretic, antibiotic, angiotensin converting enzyme inhibitor, loop diuretic and 5% and 10% glucose buffered infusion solutions.