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Medical Management of Ischemic Heart Disease

MEDICAL MANAGEMENT OF ISCHEMIC HEART DISEASE

A 67 years Male, retired civil engineer was referred to us with the following complaints -

1. Renal Disease since 10 years

He had recurrent pain in the right side of abdomen extending to the right ureter with backache. It was of a gradual onset < before stool. Ultra sonogram of the abdomen revealed a right Renal calculi (2007). The last attack occurred around 2 weeks ago. He was taking Berberis vulgaris Q (prescribed by a local homoeopath) and was relieved of the colic. He had once passed a small calculus about 5-6 years ago.

2. Diabetes Mellitus since 3 years

It was detected accidently on routine blood examination. The patient had no symptoms. He was put on oral anti-diabetics since that time.

3. Ischemic Heart Disease since 2 years

Ailments after mortification (by his son over property issue)! It started one morning when the patient had chest discomfort and flatulence followed with an unsatisfactory stool. The discomfort increased when he went to the temple about 14 Km driving his vehicle. At around 8 pm he experienced suffocation & fullness of upper abdomen + stiffness in the upper back. He was Hospitalized and diagnosed as having an Acute Anterior Wall Myocardial Infarction (20/2/11). He was thrombolysed. There after he developed gross pulmonary edema & congestive cardiac failure. His Coronary Angiography (7/3/11) revealed Triple vessel disease {LAD: 100% ostial occlusion; LCX: 70% mid-occlusion; Proximal RCA: 90% stenosed; R®L and L®L collaterals}. He was advised a Coronary artery Bypass surgery, but he refused. He was started with the following medications – Tablet Cardace 2.5 mg daily, Lasilactone10mg, Metformin 500 mg twice,    Glibenclamide 5mg twice, Clopidogrel 75 mg daily, Aspirin 325 mg daily and Atorvastatin 20 mg daily night.  He presented to us with

-         Anxiety in the region of the heart (Ghabrahat)< walking

-         Constant pressing chest pain < walking, ascending stairs

-         Palpitations after every meals

Past History- Recurrent Folliculitis before 30 years. It was treated with antibiotics. No such complaints since 25 years

Physical Generals – Chilly +, Appetite– average; could stay hungry. Desired – warm drinks. Thirst, Sweat & Urine – average. Stools were unsatisfactory, straining +, hard in consistency and 2/ 24 hours. Sleep normal. Dreams of misfortune.

Mentals – oversensitive (self respect, noise), preferred company, social, angered easily and was very expressive. Memory was sharp and his decisions were quick. Workaholic.

Family History – Father died of Pulmonary TB; Mother died. She had bronchial asthma and eczema. 2 brothers – eczema. Son – no complaints.

On Examination – Built: average, abdominal obesity+. Weight: 60Kg,

     Pulse- 84/min, regular, synchronous, good volume, non- collapsing

     BP: 130/80 mm Hg

     No Pallor, icterus, Cyanosis or clubbing

    JVP: Not raised. No edema feet

    Skin: dry scaly eruptions (fungal) on both toes, thumbs

    Ear/Nose/Throat/Tongue/Tonsils: normal

    Heart sounds pure. No gallop or murmur

    Chest clear; Air entry equal on both sides

CASE ANALYSIS

Manifestations

  1. Physiological characteristics – senile cataract
  2. Physiognomic features – average built, wheatish complexion, abdominal obesity
  3. Ailments from Mortification
  4. State – Diabetic
  5. Expressions

Acute

  • Pain right side abdomen & fullness
  • Palpitation < eating after
  • Anxiety chest (Ghabrahat)
  • Skin eruptions, dry itching & burning

Chronic

  • Pain in abdomen < stool before
  • Pain right ureteric region
  • Anxiety region of heart
  • Pain, chest constant
  • Palpitation < eating after
  • Skin , eruptions
  • Stomach, Desires warm drinks
  • Emptiness in stomach, not relieved by eating
  • Thirstless
  • Dreams of misfortune
  • Offended easily
  • Company desires
  • Chilly
  • Ailments after mortification

 

FINAL DIAGNOSIS – Psoro-sycotic state of disposition

Case Type I (Natural Case)

The following remedies came out after repertorization – Lycopodium, Sulphur, Argentinum Nitricum, Nux vomica, Acid phos

 

14/3/2011: Advised to avoid physical exertion, and calcium rich things. Tab     Lycopodium 200, 1 dose. All allopathic medicines were continued.

11/4: Fungal infection increased between the toes. Without permission he had used antifungal ointment for a week. Multiple small pustules appeared on the right upper back. History of passing sand in urine after a bout of severe renal colic. He had taken Tab Spasmoproxyvon for the renal pain. Rx: SL for 3 months

22/7: No episode of palpitations or chest discomfort in spite of doing physical exertion. Weight: 62 Kg, BP 130/80mm Hg; Vitals stable. Lipid profile – Normal. Omit tabs Lasilactone, Clopidogrel. We reduced Aspirin to 150 mg daily and Atorvastatin 10 mg daily night.  SL for 3 months

7/11: Skin eruptions decreased. Right abdominal fullness continued but less in intensity. Blood Sugar (F) - 96mg/dl & (PM) – 164mg/dl. Rx:SL for 3 months

3/3/12: Can walk up to 3.5Kms at a stretch. No breathlessness, chest discomfort or palpitation. No abdominal complaints. 2D Echo: RWMA+, Diastolic dysfunction+, EF 48%. Reduced Aspirin to 75 mg/ day and omitted Atorvastatin & Cardace.  SL x 4 months

7/10: Had gone to Mumbai for a few months. No complaints. Stopped walking but started yoga. Lipid profile / Blood sugar- normal; HBA1C – 6%. Omit Tab Glibenclamide. Continue with aspirin 50 mg/day and Metformin 500mg twice a day.

1/12: Skin dry, itching started between the toes. Blood sugar (F) – 110 & PM 138 mg/dl. Lycopodium 1M 1 dose

28/1/13: No complaints. TMT: negative for inducible ischemia. Advised for coronary angiogram

1/3/13: Coronary angiogram: Triple Vessel disease {LAD: 70% ostial occlusion; LCX: 30% stenosis. Long plaque; RCA: proximal 60% and distal 40% stenosed}

Discussion

  1. The case at hand was a natural case with a good causation for his ailments, hardly any suppressions and good mental and physical generals. Hence we could administer his constitutional drug Lycopodium directly on his first presentation
  2. It took us practically a year or more for the gradual withdrawal of allopathic medicines. It was very much possible contrary to the belief that these medicines once started need to be continued for life. It is not so in all cases.
  3. Since lycopodium was the constitutional similimum, it brought out the skin symptoms aggressively at the same time taking care of the internal pathology (atherosclerosis and diabetes)
  4. We can thus practice evidence based homoeopathy even in such cases when our approach is sound and based on strict Hahnemannian principles. 

LINK: TIA

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