Transcript CARDIAC DISEASES

CARDIAC DISEASES
Dr. A K Dwivedi
B.H.M.S., M.D.
HOD
Department of Physiology
SKRP Gujarati Homoeopathic Medical
College, Indore
Member
Board of Studies of Homoeopthy
Devi Ahilya university Indore
Director
Advanced Homoeo- health Center, Indore
9424083040,9826042287
0731,2492244, 07314064471
Heart –introduction
 Heart, in anatomy, hollow muscular organ
 it is heart shaped that pumps blood to the body.
 The heart, blood, and blood vessels make up the
circulatory system, which is responsible for
distributing oxygen and nutrients to the body and
carrying away carbon dioxide and other waste
products.
 The heart is the circulatory system’s power supply.
Structure of Heart
 Heart valves
 Heart chamber
 Myocardium
 Pericardium
 Endocardium
 Coronary arteries
Heart valves
 Four valves within the heart prevent blood from
flowing backward in the heart. The valves open
easily in the direction of blood flow, but when
blood pushes against the valves in the opposite
direction, the valves close. Two valves, known as
atrioventricular valves, are located between the
atria and ventricles.
 The other two heart valves are located between the
ventricles and arteries. They are called semilunar
valves
Heart Valves
Myocardium
 Muscle tissue, known as myocardium or
cardiac muscle, wraps around a scaffolding
of tough connective tissue to form the walls
of the heart’s chambers
Pericardium
 A tough, double-layered sac known as the
pericardium surrounds the heart. The inner
layer of the pericardium, known as the
epicardium, rests directly on top of the heart
muscle.
Endocardium
 The inner surfaces of the heart’s chambers
are lined with a thin sheet of shiny, white
tissue known as the endocardium. The same
type of tissue, more broadly referred to as
endothelium, also lines the body’s blood
vessels, forming one continuous lining
throughout the circulatory system.
Coronary arteries
 The heart is nourished not by the blood
passing through its chambers but by a
specialized network of blood vessels.
Known as the coronary arteries, these blood
vessels encircle the heart like a crown.
 Three main coronary arteries—the right, the
left circumflex, and the left anterior
descending—nourish different regions of
the heart muscle.
FUNCTION OF THE HEART
The heart’s duties are much broader than
simply pumping blood continuously
throughout life. The heart must also respond
to changes in the body’s demand for
oxygen.
 Cardiac cycle
 Heartbeat
 Heart sound
 Cardiac output
Heart Sound

Introduction: The mechanical activities of the heart during each cardiac
cycle cause the production of the some sounds, which are
called Heart Sounds.
·
·
The factors involved in the production of heart sounds
are as follows: The movements of blood through the chamber of the
heart.
The movements of cardiac muscle.
The movements of the valves of the heart.
ELECTROCARDIOGRAM
ECG is a linear graph of the voltage fluctuation
produces by the myocardium. The heart muscle
posses the property of automatic rhythmic
contraction, the impulse that arise in the
conduction system spread through out
myocardium resulting in the excitation of the
muscle fibers.
 This result in weak electric current which spread
through the entire body. This can be recorded by
placing electrode at various positions on the body
and connecting them two end electro cardiac
tropic apparatus.
Abnormalities
Absence of p wave increase of atrial
fibrillation or nodal rhythm, sino atrial
block & hypertension.
Inverted in lead I (dextocardia)
Incorrect electrode placement
Wide and notched due to left atrial
enlargement
Tall and packed due to right atrial
enlargement
 QRS Complex
 It is produced by ventricular activation on
depolarization.
 Q wave - -ve deflection that receives the R
waves. It denotes the depolarization of
ventricular septum from left to right.
 R wave is the 1st +ve deflection of QRS
complex it denotes the depolarization of
ventricles.
 S wave –v e deflection, which follows the R
wave. It occurs due to depolarization of the
postero basal part of the left ventricle.
Heart diseases
 The arteries that nourish the heart become
narrowed and unable to supply enough blood and
oxygen to the heart muscle.
 However, many other problems can also affect the
heart, including congenital defects (physical
abnormalities that are present at birth),
malfunction of the heart valves, and abnormal
heart rhythms.
 Any type of heart disease may eventually result in
heart failure, in which a weakened heart is unable
to pump sufficient blood to the body.
Major causes of heart diseases
Emotion
Fatty diet
Physical excitement
Stressful life
Coronary Heart Disease
 Coronary heart disease, the most common type of
heart disease in most industrialized countries,
 It is caused by atherosclerosis, the buildup of fatty
material called plaque on the inside of the
coronary arteries
 Over the course of many years, this plaque
narrows the arteries so that less blood can flow
through them and less oxygen reaches the heart
muscle.
The most common symptom of
coronary heart disease is
 Angina pectoris
 a squeezing
 chest pain that may radiate to the neck, jaw, back, and left
arm.
 Angina pectoris is a signal that blood flow to the heart
muscle falls short when extra work is required from the
heart muscle.
 An attack of angina is typically triggered by exercise or
other physical exertion, or by strong emotions.
 Coronary heart disease can also lead to a heart attack,
which usually develops when a blood clot forms at the site
of a plaque and severely reduces or completely stops the
flow of blood to a part of the heart.
 In a heart attack, also known as myocardial
infarction, part of the heart muscle dies because it
is deprived of oxygen. This oxygen deprivation
also causes the crushing chest pain characteristic
of a heart attack.
 Other symptoms of a heart attack include nausea,
vomiting, and profuse sweating. About one-third
of heart attacks are fatal, but patients who seek
immediate medical attention when symptoms of a
heart attack develop have a good chance of
surviving
Arteriosclerosis
 Arteriosclerosis, a group of disorders of the
arteries, the tubular vessels that carry oxygencarrying blood from the heart to the body’s organs
and tissues.
 In arteriosclerosis, the walls of the arteries
thicken, harden, and lose their elasticity. The
blood vessel channels develop twists and turns and
become narrowed so that the heart must work
harder than normal to pump blood through the
arteries. In the disease’s advanced stage, there is a
risk of a decrease in blood flow and oxygen
supply to all parts of the body.
 The most common form of arteriosclerosis
is atherosclerosis, also known as coronary
artery disease. In this condition, deposits of
plaque—a material rich in greasy
compounds called lipids, including
cholesterol—form on the inner walls of the
arteries. These deposits narrow the arterial
channels and partly block the normal flow
of blood through them.
 The symptoms of arteriosclerosis depend
upon the arteries affected. A decrease in the
flow of blood through the coronary arteries,
resulting in a shortage of oxygen going to the
heart muscle, causes chest pains, a condition
called angina pectoris.
 If a blood clot forms in a coronary artery, the
interruption of the blood flow can result in
the death of part of the heart muscle, causing
the crushing chest pains of a heart attack.
 A chronic decrease in the circulation of
blood to the heart may result in heart failure,
which is the inability of the heart muscle to
pump enough blood for the body’s
requirements. Unless treated, this condition is
fatal.
ISCHAEMIC HEART DISEASE
Ischeimcs heart disease (IHD) is defined as acute
or chronic form of cardiac disability arising from
imbalance between the myocardial supply and
demand for oxygenated blood.
Since narrowing or obstruction of the coronary
arterial system is the most common cause of
myocardial anoxia, the alternate term coronary
artery disease (CAD)' is used synonymously with
IHD. IHD 0) CAD is the leading cause of death in
most industrialised countries (about one-third of all
deaths) and somewhat low incidence is observed
in the developing countries. Men develop IHD
earlier than women and death rates are also
slightly higher for men than for women until the
ETIOPATHOGENESIS
IHD is invariably cause by disease affecting the
coronary arteries, the most prevalent being
arteriosclerosis accounting for more than 90%
cases, while other causes are responsible for less
than 10% cases 01 IHD. Therefore, it is
convenient to consider the etiology of IHD under
three broad headings:
1. Coronary atherosclerosis
2. Superadded changes in coronary atherosclerosis
3. Non-atherosclerotic causes.
Coronary Atherosclerosis
Coronary atherosclerosis resulting in 'fixed' obstruction is
the major cause of IHD in more than 90% cases. Here, a
brief account of the pathology of lesions in atherosclerotic
coronary artery disease is presented.
1. Distribution. Atherosclerotic lesions in coronary
arteries are distributed in one or more of the three major
coronary arterial trunks, the highest incidence being in the
anterior descending branch of the left coronary, followed
in decreasing frequency, by: the right coronary artery and
stil1.1ess in circumflex branch of the left coronary. About
one-third of cases have single-vessel disease, most often
left anterior descending arterial involvement; another onethird have two-vessel disease, and the remainder have
three major vessel disease.
2. Location. Almost all adults’ show atherosclerotic
plaques scattered throughout the coronary arterial
system. However, significant stenotic lesions that
may produce chronic myocardial ischaemia show
more than 75% (three-fourth) reduction in the
cross-sectional area of a coronary artery or its
branch. The area of severest - involvement is
about 3 to 4 cm from the coronary ostia, more
often at or near the bifurcation of the arteries,
suggesting the role of haemodynamic forces in
atherogenesis.
Fixed
atherosclerotic
plaques.
The
atherosclerotic plaques in the coronaries are more
often eccentrically located bulging into the lumen
from one side. Occasionally, there may be
concentric thickening of the wall of the artery.
Atherosclerosis
produces
gradual
luminal
narrowing that may eventually lead to 'fixed'
coronary obstruction. The general features of
atheromas of coronary arteries are similar to those
affecting elsewhere in the body and may develop
similar complications like calcificatiQl1, coronary
thrombosis, ulceration haemorrage, rupture and
aneurysm formation.
3.
ANGINA PECTORIS
Angina pectoris is a clinical syndrome of IHD resulting
from transient myocardial ischaemia. It is
characterised by paraxysmal pain in the substernal or
precardial region of the chest which is aggravated by
an increase in the demand of the heart and relieved by
a decrease in the work of the heart. Often, the pain
radiates to the left arm, neck, jaw or right arm.
There are 3 overlapping clinical patterns of angina pectoris
with some differences in their pathogenesis:
I.
Stable or typical angina
II.
Prinzmetal's variant angina
III. Unstable or crescendo angina
SHOCK
 Shock is complex clinical syndrome in
which the circulatory system fails to
maintain cellular perfusion and function
CAUSATION
 Hypovolaemia (decreased circulating blood
volume )
 Cardiogenic shock (decreased pump
function of heart)
 Distributive shock(relative Hypovolaemia
due to vasodialatation)
Clinical features
 Fast and thready pulse
 Severe fall in B.P.
 Cold clammy hand and feets
 Fast shallow breathing
 Confusion, loss of consciousness
 Renal shut down(oliguria/anuria)
 Multiorgan failure
Mitral stenosis
 The mitral valve is most frequently damaged by
rheumatic carditis and mitral stenosis is most
frequent valvular lesion of established RHD
CLINICAL FEATURES
 Dyspnoea
 Palpitation
 Pulsus parvus
 Mitral facies
 Taping apex beat , diastolic thrill
 Loud first sound
 ECG-LA enlargement
ACUTE PULMONARY OEDEMA
 Transudation of fluid from pulmonary
capillaries into the alveoli result in
pulmonary capillaries into the perivascular
space but not to the alveoli causes
interstitial pulmonary oedema, a step prior
to the development of pulmonary oedema
CLINICAL FEATURES
The patient is
Dyspnoeic & restless
Anxious
Cyanosed & profusely sweating
Respiration is rapid
Blood pressure is raised
MYOCARDIAL DISEASE
 There are two blood groups of myocardial
diseases
 Myocarditis
Inflammation of heart muscles
is called myocarditis
 Cardiomyopathy
Non-inflammatory
myocardium involvement with unknown
(primary) or known (secondary) etiology
HEART FAILURE
It is the patho-physiologic state in which impure
cardiac function is unable to maintain an adequate
circulation for the metabolic needs of the tissue of
the body.
CLINICAL FEATURES
 Dyspnoeic & orthoponeic
 Fast & low volume pulse, pulsus alternans in LVF
 Cold hands and feet with peripheral cyanosis of
nails and lips
 Raised JVP, positive abdomino-jugular reflux
 Cardiac enlargement (apex beat shifted
down and out)
 RV hypertrophy seen as left parasternal and
epigastric pulsation
 Percussion confirms cardiac
 auscultation -1st sound variable, pulmonary
component of 2nd sound loud, 3rd and 4th
sound may be audible.
MANAGEMENT OF
CARDIAC DISEASES
1.




Specialised diagnostic studies may be benefit in
management of the patient such as
M.R.I.
Ultrasonography for abdominal aortic aneurysm
Cardiac catheterisation in the case of cardiogenic
shock, massive pulmonary embolus
Echocardiography for VSD. Pericardial effusion
2. Rest –
 reduces the demand on the heart
 Adequate rest reduces venous pressure and
pulmonary congestion
3. Diet –
 Obese patient require a low calorie diet
 Fried food are avoided
 Fat is reduced
 Protein content is kept normal(50-70gm)
 Sodium content should not exceed 6gm of salt
 Vitamin supplement may be required
To understand cardia and
cardiac diseases with
Homoeopathy
ACONITUM NAPELLUS
 Palpitation of the heart in young
• Growing person and plethoric individuals
• Congestion to both heart & lungs
• Palpitation with anxiety
• Cardiac oppression & even syncope
• Fear of death
• Hyperaemia preceding endocarditis
• Confused & nervous in crowd,raises
blood from least excitement
APIS MELLIFICA
• Cardiac inflammation & dropsy
• Sudden lancinating ,darting or stinging
pain just below the heart, soon extending
daigonally towards the right chest
• Grat feeling of suffocation, its seems he
would smother for want of air
• Oedema or sudden mucus swelling
• Dysnoea fidgety restlessness and anxiety,
blowing sound with the diastole
• Pericarditis and hydropericardium
• Pulse not steady, irregular, intermitting
every 3rd or 4th beat
APOCYNUM CANNABINUM
 Hydropericardium, heart’s action scarcely
perceptible, face bloated and anxious
looking can hardly speak for want of
breathe
 Great dysnoea, wheezing breathing cough
 pulse slow, small, irregular
 General dropsy
 Urine scanty
Arsenicum album
 Cardiac cachexia
 Endocariditis, pericaditis with restlessness
 Irritable heart, trembling, irregular action of
heart, intermitting
 Palpitation with anguish
 Valvular disease with intermittent pulse,
dysnoea, anasarca
 Hydrothorax and hydropericardium, with
spells of suffocation
AURUM METALLICUM
 Pure cardiac hypertrophy without dilatation,
with increased force of heart stroke and
hyperaemia of lungs
 Endocarditis with loud endocardial bruits of
fluttering action of heart or sudden jerks
through the heart
 there is violent palpitation and anxiety with
congestion of blood to head and chest after
exertion
 Pain in heart region extends down the left arm
to fingers
 Pulse is small feeble but rapid and irregular
CACTUS GRANDIFLORUS
 Snaguinous congestion to chest
 Endocarditis and pericarditis
 Sensation of constriction of heart, as if it were
compressed or squeezed by a hand
 Violent constriction of heart muscle, throwing the
blood with great force into the aorta
 Enlargement of left ventricle with grat irregularity
of heart’s action
 Pulse is quick, throbbing, tense and hard
 Endocardial murmurs
Calcarea arsenicum
 Dysnoea from a feeble heart
 The slightest emotion causes palpitation of
heart
 Heart is missing at every 4th beat
 Constriction and pain in the region of heart
 Suffocative feeing
 Oppression and throbbing with pain in back
extending to arms
DIGITALIS PUPUREA
 Subacute inflammation of heart
 Feeble,irregular pulse
 Spasmodic cough with expectoration,mixed
with blood
 Organic diseases of the heart , sensation as
if the heart would stop beating if she moved
 Pericarditis,pericardial effusion with
consequent dropsy
 Very slow,weak,intermitting every 3rd,5th &
7th beat
Gelsemium
 Cardiac neurosis with deficient power &
action
 Dulness,diziness,drowsiness & trembling or
tremor
 Irregular beating of heart
 Heart’s action slow & feeble
 Beats cannot be felt
LACHESIS
 Late stage of rheumatismus cordis
 Sensations as if heart is too large for the
containing cavity
 Oppressive pain in the chest with feeling of
expansion of the heart as if full of wind
 Pulse weak and intermittent
 Atheromatous condition of arteries in the
aged and drunkards
 Hydropericardium and hydrothorax from
organic trouble of heart
LYCOPODIUM CLAVATUM
•
•
•
•
Dialated heart
Palpitation nearly every evening in bed
Pulsating tearing in cardiac region
Pulse unaltered, accelerated only after
eating
• Sensation as if circulation stood still or
ebullition of blood
NAJA TRIPUDIANS
 Endocarditis
 Valvular lesion
 Threatened paralysis of heart
 Sense of oppression in chest as if hot iron
had been run into it and the big weight put
upon it
NATRUM MURIATICUM
 Feeling of coldness about heart during
mental exertion
 Hypertrophy of heart
 Anxious palpitation with morning headache
 Pulse full and slow or weak and rapid,
intermits every 3rd beat
 Chronic valvular troubles with weak faint
feeling
 Heart diseases causes dropsy
OXALIC ACID
 Soreness and stitches in heart, from behind
forward and from above downward
 Sharp lancinating pains through the lower
lobe of the left lung
 Difficult breathing with choking feeing in
larynx
 Loss of voice alternates with palpitation
 Stitching pain behind the sternum
PHOSPHORUS
 Cardiac diseases of the right heart with
venous stagnation
 Endocarditis or myocarditis during acute
inflammatory rheumatism or during
pneumonia
 Anguish about the heart with nausea and
peculiar sensation of hunger
 Systolic bellows’ about heart with nausea
and peculiar sensation of hunger
PLUMBUM
 Chronic endocarditis and endarteritis
 Hypertrophy and artheroma of aorta followed
by dialatation of ventricles
 Anxiety about heart
 Frequent violent palpitation
 Dyspnoea and threatening suffocation
 Basic murmur specially systolic
 Impulse of heart feeble intermittent
 Sounds of heart indistinct
 Pulse soft compressible, intermittent
SPIGELIA
 Rheumatic pericarditis and endocarditis
 Sharp pain shooting through heart to back
or radiating from heart down the arm or
over the chest and down the spine
 Irregularity of heart beat with violent
palpitation
 Visible, audible, violent and roaring heart
with systolic blowing at apex
 Great dyspnoea at every change of position
TABACUM
 Dialated heart frequent pallor with lividity
of face
 Palpitation when lying on left side
 Paroxysms of suffocation with tightness
across upper part of chest
 Pains shoots from heart down left arm and
up into neck
 Intermittent pulse
VIPERA
 Violent pain in chest, with chilliness
 Bloating up of chest with difficulty of
breathing
 Violent congestion of heart, he tears his
clothing open
 Anguish about the heart
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