Myocardial Infarction and its
Homoeopathic Management
Pawan Satyanarayan
Chandak
Coronary Heart
Disease is the leading cause 25-30% of death in most industrialized
countries.On screening of persons over the age of 30 years by a 12-lead ECG, I
Chandigarh (urban population) the prevalence was found to be 65.4 and
47.8 per 1000 males and female respectively.
Myocardial infarction:
It deals with problems associated with
blockage of the coronary arteries. These vessels normally Supply
oxygenated blood to the heart muscles. Blockage of the coronary vessel
may occur abruptly secondary to a blood clot or spasm of one of the
coronary vessels.Most often this occurs in a coronary artery that has been, narrowed
from the progressive effects of atherosclerosis.
Angina:
It means chest pain as a result of the hart’s inability
to receive adequate blood flow (and oxygen). When the blood flow is
completely interrupted myocardial infarction (heart attack) results.Angina may be further described as ‘stable’ meaning to chest pain
is controlled and typical.Or ‘unstable’ meaning that the chest pain ‘brand new’ or
increasing in severity and in frequency
Coronary artery disease:
It describes the problem more
separately. When the coronary arteries have become narrowed the are
considered ‘diseased’. This occurs through a gradual occlusive
process in the arteries known as Atherosclerosis.Patient with coronary artery disease are at risk for myocardial
infarction.
Risk factors for Coronary Artery Disease:
Smoking Obesity Diabetes Hypertension Family History of heart attack (parents or sibling) High blood cholesterol Prior Heart attack Low HDL lipoprotein level Elevated LDL level High blood triglycerides
Clinical Features:
Common symptoms of acute myocardial infarction:
Substernal (mid-chest) discomfort – this is usually a dull
pain that may radiate to the arm or ‘jaw’.
Associated symptoms:
Shortness of breath, sweating and nausea.
Typically the pain is provoked by exertion.
Myocardial infarction occurs more commonly in males over the age of
26.An myocardial infarction under the age of 26 in male and under the
age of 35 in female is unusual.Aproxiamately 10% patirents having a myocardial infarction may have
few symptoms (silent MI) or not at all.Mi is more commonly in elderly persons and in those with history of
diabetes.Cardiac symptoms can vary in some patients.
Some patients may experience ‘chest tightness’, upper
abdominal pain (that radiate to the back) and or sudden sweating
with or without shortness of breath.Due to myriad of presentation a detailed evaluation is critical.
Detailed Evaluation:
History and physical examination.
Clinical finding may include a rapid pulse or irregular pulse.
The patient who is experiencing an MI will more often than not, have
clear evidence for a heart attack on their electrocardiogram.Other tests that are helpful include.
- Repeated ECG
- Chest X-ray
- Blood test
includes Complete Blood count, Test of cardiac
enzymes, Blood electrolytes and coagulation profile.- Observation of cardiac rhythm on cardiac monitor.
The patient who is at risk for coronary artery disease but is not
currently experiencing chest pain might undergo an evaluation that would
include any of the following.
– Stress test
– Thallium heart scan
– Cardiac cathetarisation
– ECG
– Echocardiography.
– Blood cholesterol
– Chest X-ray
– Holter monitoring
– MUCVA scan
General management:
Treatment of acute chest pain thought secondary to coronary artery
disease warrant hospitalization and control of chest pain medications
and supplementary oxygen.
Emergency management:
Thrombolytic agent
Surgical management:
Angioplasty PTCA
Coronary artery bypass
Complications:
– Arrthmia
– Cardiogenic shock
– Sudden cardiac death
– Extension of MI
– Congestive cardiac Failure
– Side effects of the use of thrombolytic medication (e.g.
haemorrhage)
How to lessen the cardiac risk:
Stop smoking Observe the diet low in fat and cholesterol. Sodium chloride intake should be < 6 grams/day Regular exercise within tolerance level Keep the body weight within recommended level. Have an annual physician examination that includes ECG, cholesterol
test. LDL cholesterol less than 130, HDL > 40, triglycerides < 200.Close control of Diabetes. Vitamin E administration of 200-400 IU can decrease the level of
LDL.See a physician immediately if you are experiencing chest pain or
any potential cardiac symptoms.
Homoeopathic Management:
Homoeopathy have widest scope in the management of cases of coronary
artery disease.If we go through specifics following medicines are very useful.
ACONITE (3). Attacks of intense pain extending from the
heart down the left arm, with numbness and tingling of fingers and fear
and anxiety that he will drop dead in the street. Nervous and
confused in a crowd. Palpitations with anxiety, cardiac oppression, and
syncope. Palpitations < when walking, lancinating stitches prevent the patient from assuming the erect position or taking a deep breath. Panic
attacks.
ARNICA (3).
Strain to the heart muscle, producing
uncomplicated hypertrophy, with swelling of hand from any exertion,
hands turn red when hanging down. Heart feels as if tightly grasped by
the hand the whole chest feels sore and bruised and cannot bear the
clothing to touch it. Pulse is full and strong. Tells everyone he is
fine and does not want to be approached. Often the first remedy to
use, especially if the heart attack has been brought on by exertion.
CACTUS (3).
Sensation of constriction of the heart, feels as
if it were compressed or squeezed by an iron hand. Heart pains come
on slowly, gradually increase then gradually subside. Angina pectoris,
with suffocation, cold sweat and ever-present iron band feeling. Blood
clots. Pulse feeble, irregular quick, without strength. Melancholic,
taciturn, sad, and ill humored. Worse < about noon, lying on the left side, walking, going upstairs. 11 a.m. and 11 p.m. Better > open air.
DIGITALIS (2).
Sudden sensation that the heart stood still. Pulse
very small, slow, feeble, intermitting every third, fifth and seventh
beat. Feels as if the heart would stop beating if she moved.
Blueness, coldness and suffocation. Despondency, fearful, anxious for
the future. Worse < when sitting erect, after meals, music.Better > when stomach is empty, in open air.
KALMIA (2).
Sharp, severe pains about heart taking way the breath
with shooting down into stomach and abdomen with slow pulse and numb
feelings in left arm. Pains often travel downward in heart attacks.
Rapid and visible beating of the heat, paroxysms of anguish with great
breathlessness, pains in limbs, stitching lower part of chest, right
sided face ache.
Worse < when bending over and better > by sitting erect.
LACHESIS (3).
Great loquacity jumps from on subject to
another. Fits of suffocation and fainting, especially when moving, pulse
weak, intermittent, stitches in left side of chest. Can’t bear
anything tight around the neck or waist. Horrible, smothering
feeling about the heart awaking him from sleep and compelling him to
leave the bed, dread of going to sleep on account of marked aggravation.
Pain begins on the left and extends to the right. The face is
purple, mottled puffed. looks swollen and bloated.
Worse < sleep, and on going to sleep, left side,
and heat.
LACTRODECTUS MACTANS (3).
The bite of this spider simulates a
heart attack. Constriction of the chest muscles, with radiation to the
back. Gasping breath. Violent, pericardial pain extending to the
axilla down the arm and forearm to fingers with numbness of extremity. Pulse
feeble and rapid. Skin as cold as marble. Fears losing his breath.
Use this remedy if no other is specifically indicated.
LAUROCERASUS (2).
Sensation as if the heart would turn over,
causing him to gasp for breath, worse when lying down. Spasmodic
tickling cough in cardiac patients. Breathlessness worse < from lying down, motion, stooping, eating, drinking, or warmth.
NAJA (2).
Sense of oppression in chest, as if a hot iron had
been run into it and a big weight put upon it. Angina, threatened
paralysis of the heart, body cold, pulse slow, weak, irregular and
tremulous. Angina pains extending to the nape of neck, left
shoulder and arm with anxiety and fear of death Can not lie on
left side, but has great > relief of pain and breathlessness when
lying on right side.Worse < from stimulants.
Better > walking of riding in open air.
SPIGELIA (2).
Great breathlessness at every change of
position. Breathlessness, must lie on right side with head high.
Sharp, shooting pains from the heart to the back, radiating form the
heart down the arm, over the chest, and down the spine. Great weakness
of the body after walking, Great oppression or anxiety about the heart.
Craving for hot water which > ameliorates. Fear of sharp pointed
things such as needle and pins, afraid of injections and acupuncture.Worse < from touch, motion, noise, turning , washing , concussion.
Better > lying on right side with head high, inspiring.
TARENTULA (2).
Heart suddenly ceases to beat, with fear of
death and constant want of air. Trembling and thumbing of the heart
as from a fright. Palpitation with praecordial anguish, sensation as if
heart twisted and turned around. Heart attack from seeing others in
trouble. Extreme restlessness.Worse < motion, contact, noise, seeing others in trouble.
Better > in open air, music, bright colors, rubbing
affected parts.
Repertorium
HEART, attack, angina pectoris – ACON., apis., arg-n., ARN., ars.,
aur., CACT., carbo-v., Dig., Glon., iod., Kalm, LACH., LAT-M., Laur.,
Naja., nux-v., phos., rhus-t., Spig., verat., Tarent.
Mind –
Anguish with great breathlessness -Kalm.
Anxiety he will drop dead in the street- Acon.
Anxious for the future.- dig., spig.
Despondency- dig.
Fear
–
Death, during – ACON., ars., cact., DIG., Naja, Phos., tarent.
Losing his breath. – Lat-m.
Sharp pointed things such as needle and pins, afraid of injections
and acupuncture – Spig.Fine, tells everyone he’s is – ARN.,
Loquacity, great, jumps from on subject to another – LACH.
Melancholic, taciturn, sad and ill humored – Cact.
Panic – ACON.
Restlessness, extreme – TARENT.
Pain –
Extensions-
Angina pains extending to the nape of neck, left shoulder and arm
with anxiety and fear of death – Naja.Downward, pains often travel, in heart attacks – Kalm.
Left arm, extending from the heart to, with numbness and tingling of
fingers – ACON.Left to right – LACH.
Violent, praecordial pain extending to the axilla down the arm and
forearm to fingers with numbness of extremity – LAT-M.Come on slowly, gradually increase then gradually subside – cact.
Hand –
Squeezed by an iron hand, as if – CACT.
Tightly grasped by the hand, as if -arn.
left sided – LACH.
Sore and bruised, chest feels – ARN.
Stopped, sensation as if – Arg-n., Aur., Cact., DIG., Lach., tarent.
Stop beating, feels as if the heart would, if she moved- DIG.
References:
– Atherosclerosis: a major cause of cardiovascular Disease: a
publication of American heart Association.http://www.reg.uci.edu/UCI/CARDIOLOGY/PREVENTIVE/FACTS/athero.html.
– Facts about angina
– Heart attack
http://sln.fi.edu/biscci/healthy/attack.html
-Alcohol and Heart disease
http://www.cardio.com/articles/alcohol.htm
– Heart disease: symptoms Md Interactive
http://www.buissness1.com/mdinteract/CARDIOLOGY.html
– Preventive and Social Medicine – Dr. Park
– Medicine – Davidson
– Gems of Modern Homoeopathy – Dr. P.S. Chindak & Dr. J.D.
Patil– 6th revised edition of Kent’s Homoeopathic Repertory
– Pocket Manual of Homoeopathic Materia Medica and Repertory – Dr.
William Boericke.– Synthetic Repertory
– Clinical Materia Medica – Dr. E.A. Farrington
Copyright
© Pawan Satyanarayan Chandak 2005
