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Creating Waves of Awareness

Over the past several decades, cardiologists the world over, have tended to view coronary artery disease in terms of a “culprit lesion” hypothesis. This view allowed the materialistic school to focus on a specific lesion to develop site-specific diagnostic and therapeutic approaches. First there was quantification of a specific lesion using coronary angiography, then its extermination by Per cutaneous trans dermal coronary angioplasty (PTCA), intracoronary thrombolysis, atherectomy, stents and so on. They even transmitted this idea to their patients when reviewing their findings by using language like, “you had a blockage that we took care of.”

The impact and the persuasion is such that many patients come back and ask us homoeopaths as well, “how is that lesion or blockage?” or “how do you know that it’s not come back?” and “should we take another angiogram to look at it?” They even indirectly imparted the idea that they took care of their entire problem when they treated that specific lesion. Alternatively, when they could not find a specific lesion severe enough to account for clinical findings the tendency was to tell their patients that they only had a mild disease and that in future a full fledged plaque may develop.

But it has become apparent even to the so called modern school of therapeutics that if they are to make vital and lasting impacts on the outcome of this disease, then they must move beyond this type of narrow thinking. The culprit lesion notion was wishful thinking on their part that the key to this illness could be localized to a specific site in a portion of a large coronary artery. While this was important for the acute thrombotic occlusion found in the early hours of myocardial infarction, but the pathologists have become preoccupied with this finding.

How could the established and growing list of risk factor conditions for this disorder, which are all systemic such as increased LDL, hypertension, diabetes mellitis, hyper-insulinemia, inflamation, etc., resting on the fundamental bedrock of an active Tubercular (Psoro-sycotic or Psoro-syphilitic or Psoro-syco-syphilitic) miasmatic state be expected to cause only a culprit lesion? or a singular pathology. Intracoronary ultrasound and even some angiography studies have identified more then one site of complex plaque or thrombus. Multiple sites of rupture-vulnerable plaque are clearly present in those with what was previously termed only mild or minimal disease. And in those with more severe stenoses it seems that the severe stenosis is a marker for many more rupture-vulnerable plaques at other sites.

Also, studies using radionuclide perfusion or directly measured coronary blood flow by Doppler wire have confirmed functional abnormalities at the small artery and arteriole level even when the more proximal lesions are not flow limiting.

These microvessels had generally been thought to be spared of athererosclerotic disease because of the absence of a large plaque. It is now clear that these dysfunctional microvessels fail to dilate appropriatly to myocardial demands and contribute to malperfusion.

Thus, it seems reasonable to extend our thinking of this disease to one with generalized arterial involvement. Perhaps “panarterial” or even “arteriopathy” would be more useful terms to help better convey what we now know about the disease.

Further more, it is wise to know that the basic disorder is the “tendency to atherogenesis”, due to an activated tubercular miasmatic state, where as the arteriopathy is the pathological result of the disease. This notion conveys the message that the disease extends well beyond a localized site in a coronary artery. Indeed, early manifestations of panarterial atherogenesis are detected as endothelial dysfunction of the peripheral arteries of young individuals with risk factor conditions.

It is also likely that rupture-vulnerable plaque is present in other arteries but only becomes clinically apparent when rupture occurs in the coronary or cerebral arteries or the aorta. It has long been recognized that there is a heightened frequency of stroke associated with acute coronary syndromes.
The latter was believed due to cerebral embolization of ventricular mural thrombus. But it is likely that some of these strokes relate to embolization from complex lesions in the aorta, carotid and vertebral systems. Further, the homoepathic remedies that help to decrease the adverse outcomes of this disease (including lifestyle modification) have their actions on at the luminal surface of all arteries (endothelium) through the vital force. Herein lies the most positive potential benefit from a shift in thinking toward a more systemic disease. If we were to make a concentrated attempt to think of this disease as a panarteriopathy rather than a culprit lesion, perhaps we could better influence patients and practitioners to heed advice relating to the need for constitutional treatments i.e to cure the tendency of atherogenesis.

As Late Dr. J.N.Kanjilal (a doyen of Homoeopathy in India) pens “theory, practice and experience are closely interlinked and mutually complementary. A theory, if it has to be substantial, must originate from practice, by the process of induction. A substantial theory usually evolves from the generelaization of a particular fact observed in all cases of a particular branch of practice when it assumes the prestige of a Law of Nature. Thus a real theory originates from and is sustained by true practice.” In this way alone we may be better able to impact the outcome of this disease in the new millennium.

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Comment by Dr. Aadil Chimthanawala on August 22, 2010 at 7:57am
Thanx Dr. Sushil.. U have indeed put forth my point of view very well in ur comment
Comment by DR. Sushil Bahl on August 22, 2010 at 6:17am
I think, except Surgeons, other conventional Doctors, more or less are thinking on the same lines,today as described by you. Conventional Doctors are also trying both for preventive measures and treating Atherogenesis, as such in the early stages.The exact reason why atheromas form is a bit unclear even today.

But, what you presented is also a truth. Once it comes to heart, their thoughts are completely focused to the organ and that follows what you said.Conventional medical doctors have been trained to be organ specific, hence it is their normal reaction.

Debby asked:" What of the emotional component connected to the heart?"

There are studies that show that our DNA is also affected by our thoughts and emotions. Positive thoughts have a lengthening and unwinding effect, making proper replication easier. However negative thoughts shorten and compact our DNA which increases our changes of malfunctions and improper replication that can lead to disease and deformity and early ageing. It certainly effects Heart and related pathology.

Since Homoeopathy aims at treating individual, considering totality of symptoms, including, mental, Generals, Miasmatic, constitutional etc, so it definitely has an edge, in treating Arteriosclerosis,Atherogenesis and almost all broader changes in human body.
Comment by Dr. Aadil Chimthanawala on August 21, 2010 at 10:37pm
Thanx Muhammad, Debby and Jennifer. The aim of this write-up is to change the approach of both the physicians dealing with and patients suffering from Atherosclerotic coronary artery disease.. If that approach becomes broad-based, a revolution in therapy is not far for treating this metabolic syndrome
Comment by Jennifer Kaye Mast on August 21, 2010 at 10:31pm
Thank you for such an enlightening discussion. We obviously have so much more to learn about a disease that is so prevalent today in both males and females and how we as homeopaths can have an impact.
Comment by Debby Bruck on August 21, 2010 at 9:55am
Fascinating discussion. I hope many more contribute thoughts here. What of the emotional component connected to the heart? That with malfunction of heart comes depression, and many more related diseases.
Comment by Dr Muhammed Rafeeque on August 21, 2010 at 7:02am
The heart gives us a billion dollar worth lesson: Heart is full of blood, but, he is seriously affected by a lack of blood supply. He is only bothered about giving blood to others, he never takes the blood directly from his own body, and depends on the narrow coronary vessels. His only motto is to serve others!

I wonder, why God has not given some special channels through which the cardiac muscles can take the oxygen and other nutrients directly. God has prevented this by providing a water-tight endocardium and layers of thick muscles. And he has selected a different route, may be due to this reason: When the blood is taken directly, high pressure inside the heart may cause overfilling, edema and rupture of vessels. God might have thought that, blood supply through the narrow coronary vessels is the only way to force the stupid human beings to maintain a healthy life style and keep them free from all bad habits. Hence, the 'ST' changes in the ECG is a warning from the God almighty!

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