Read this essay to learn about Cardiovascular Diseases. After reading this essay you will learn about: 1. Acute Pericarditis 2. Acute Endocarditis 3. Angina Pectoris 4. Myocardial Infarction 5. Acute Rheumatic Fever 6. Hypertension 7. Mitral Stenosis 8. Mitral Regurgitation 9. Cardiac Dilatation 10. Hypertrophy of Heart 11. Intermittent Claudication 12. Superficial Thrombophlebitis.

Contents:

  1. Essay on Acute Pericarditis:
  2. Essay on Acute Endocarditis:
  3. Essay on Angina Pectoris:
  4. Essay on Myocardial Infarction:
  5. Acute Rheumatic Fever
  6. Hypertension
  7. Mitral Stenosis
  8. Mitral Regurgitation
  9. Cardiac Dilatation
  10. Hypertrophy of Heart
  11. Intermittent Claudication
  12. Superficial Thrombophlebitis.

Essay on Cardiovascular Disease # 1. Acute Pericarditis:

There is a raised temperature, patient is in an evident distress, pericardial friction sound rub is audible. The condition is ACUTE PERICARDITIS.

On examination we find precordial area of dullness is increased, the shape of dullness being pyramidal with the point upwards. This condition is found associated with many acute diseases and specially rheumatic fever. This fever can come insidiously without pain or dullness. The typical constitutional symptoms like anxiety, distressing look, puffiness of the face, but not amounting to oedema.

Rapid pulse and fever, rapid breathing, and pain in the left chest is noticed. The commonest remedies to our mind at this point are Aconite, Arsenic alb. Apis.

Aconite:

Has a great fear, anxiety, distress is seen on the face, even fears of death. This ailment may even start with fear. The heart pains radiate to the left shoulder with tachycardia, and palpitation. The pulse is fast, full, hard and bounding.

Arsenic alb:

Restlessness and anguish is the character. Pains are in the heart and extend up to neck and occiput, with anxiety. The pulse is more rapid in the morning, and palpitation is worse lying on the back, and ascending steps. Visible pulsation and beats are audible. Mostly, these are smokers or tobacco-chewers.

Apis:

Is fussy and fidgety. Chest feels beaten and bruised. The heart beats shake the whole body. Stitching pains travel backwards from apex. Palpitation of the heart, scanty secretions of urine, the pulse is hard, small, intermittent and quick but weak. Often associated with organic heart disease.

But during the second stage that follows this, within a day or two, there is effusion while pain and tenderness diminishes. Breathlessness and other symptoms continue, cough becomes more troublesome. The breathing becomes panting, short dry cough with suprastemal pain. Apis still remains an indicated remedy.

Colchicum:

Complaints of old people. Asthmatics and of gouty constitution and uric acid diathesis. There is anxiety in the region of heart, pressure and oppression in the region of heart, sound in the heart becomes weaker and pulse of low tension, cutting and stinging of heart. The pulse is thready and imperceptible.

Kali carb:

The mind is full of fear and imagination, particularly when alone. Very anxious about his disease condition. Violent palpitation shakes the whole body, throbbing, extending to the tip of the fingers. Heart pains radiate to the left shoulder, associated with arrhythmia.

Spigelia:

Specially adapted to anaemic, debilitated and rheumatic constitution. Violent palpitation, audible, and accompany symptoms of other diseases as well. Violent sticking, and or compressive pains, radiating to arms, throat and scapula. Craves for hot water that relieves. Rheumatic carditis, trembling pulse and the whole left side is sore.

Precordial pains are aggravated by movements. Duration and course of this pericarditis widely varies, but the average is about two to three weeks. It may undergo resolution with or without the formation of adhesions.

Essay on Cardiovascular Disease # 2. Acute Endocarditis:

The patient is elderly, pale, often anaemic, and ill. Intermittently pyrexial and complains of myalgia, and arthralgia. The persistence of fever and development of heart murmurs after an acute suppurative illness like pneumonia or meningitis. ACUTE ENDOCARDITIS is suspected.

Clinically, this endocarditis could be sub-acute endocarditis, but for the purpose of treatment remedies remain same. The remedies are listed under acute pericarditis. We consider some more remedies with the sphere of action on the cardiac pathology:

Aurum met. and Aurum mur.:

These remedies should be considered usually when there is arteriosclerosis, high blood pressure, and nightly paroxysms of pain behind the sternum. Presence of valvular lesions of arteriosclerosis, with a sensation of heart being stopped beating for two or three seconds, followed by sinking sensation behind the epigastrium. Violent palpitation and oppression of the heart.

The pulse is rapid, feeble and irregular, with visible throbbing of the carotid.

Kalmia latifolia:

It is heart, nerve and rheumatic remedy. The heart’s action is tumultuous, rapid and visible. There is anguish around the heart, fluttering of the heart, with anxiety. Pains are sharp and burning, shooting, radiating to left scapula, and the palpitation is worse on leaning forward.

Often there will be gouty and rheumatic metastasis of heart. There is tachycardia with pain. The salient features are wandering rheumatic pain which travels from above downwards, tumultuous action of the heart and slow pulse.

Spigelia:

Has violent palpitations, audible, attending with symptoms of other diseases. Throbbing of carotids. Violent and sticking compressive type of pains. Soreness and purring of the heart. Pulse is trembling and rheumatic carditis. The whole left side is sore.

Veratrum viridae:

Constant dull burning pain in the region of the heart; there is beating of pulses throughout the body but the pulse is slow, soft and weak. Irregular and intermittent. Veratrum v., is known to produce violent congestive conditions. Induces fall in systolic and diastolic blood pressure. Paroxysms of auricular fibrillation. After the treatment of Endocarditis a constitutional remedy should be prescribed to develop immunity.

Essay on Cardiovascular Disease # 3. Angina Pectoris:

A post-mid-life patient is attacked by constrictive pain in the chest. The condition is ANGINA PECTORIS. Chest pain is the most classical symptom associated with ischaemia of the heart disease. Classical or exertional angina, that is related to exertion, especially after a meal or in cold weather, or walking against the wind that provokes the pain.

Also aggravated by anger or excitement. The pain vanishes promptly when the exertion stops.

Decubitus angina:

That occurs when the patient lies down or takes a recumbent posture. This occurs in association with heart failure.

Nocturnal angina:

This wakes the patient from sleep. May be provoked by vivid dreams. Patients with symptoms of critical coronary artery disease have this form.

Variant angina: (Prinzmetal’s Angina):

Has no obvious provocation it occurs at rest, especially at night, or in the early morning and rarely induced by exertion. Women are more affected, and there is elevation of ST segment during the attack.

Unstable Angina:

Includes angina of recent origin angina, at rest or pre-infarction angina.

Treatment:

The remedies will depend upon the expressions presented by the patient, it does not matter then what type of angina it is. General remedies which cover the pathogenesis of the Angina are: Amyl Nit., Arnica, Aurum met. Cactus, Spigelia, Latrodectus mactans, Lilium tigrinum.

Amyl nit.:

The most striking symptom is deep facial flushing and pulsation all over the body with the palpitation of the heart. This is followed by drenching sweats. There is aching pain and constrictions around the heart with great anxiety. Precordial pain extends to the right arm. The pulse is strong and full.

Arnica:

Violent running, causing strain of the heart, palpitation and the pain extending to the left elbow and the arm. Heart pains travel from right to the left with stitching in the heart. There is constant fear of death with cardiac distress at night. The pulse is feeble and irregular.

Aurum met.:

No other remedy produces more acute mental depression than Aurum met. Complaints after grief, fright, anger, disappointed love, contradiction, reserved displeasure, financial loss may bring on angina pains. There is sensation as if the heart has stopped beating. Heart feels bruised and sore, worse by suppressed foot sweat. The pulse is rapid, feeble, and irregular. Temporal and carotid arteries throb.

Cactus:

Is indicated where the heart is weak and arteries atheromatous. The chief action of Cactus centers around heart and circulation. It acts on the circular muscular fibers, hence there are constrictions. This is followed by general weakness and prostration.

The constriction is as from the iron band. Palpitations are worse lying on the left side. At the approach of menses heart disease with the edema of the left hand. Usually useful in tobacco heart.

Spigelia:

Violent pains is the key-note of the remedial action. Violent palpitation that attend other symptoms. Throbbing of carotids and of subclavian arteries, violent sticking and compressive pains radiating to throat, arms, scapula, worse by least motion. Soreness, cracking and purring in the region of the heart. Whole left side is sore, pulse is intermittent and weak, stremulous, irregular. Better on lying on the right side.

Latrodectus mactans:

Affects the heart producing a typical picture of angina pectoris, restlessness with heart pains and prostration are the most important symptoms. Constriction of chest muscles radiating to the shoulders and back. This spider poison brings on a total degenerating effect on the blood.

Precordial anxiety, and violent pains sharp and extending to shoulders or both arms to fingers with numbness. Feeble pulse that can be hardly counted.

Lilium tigrinum:

Has its main action on the venous circulation, the heart and the female organs. There is a sensation as if the heart is grasped in a vise. Feels clutched, full, bursting, cold, weak, hanging by thread. Palpitation, with the pain in cardiac region with a feeling of a load on chest, suffocation feeling in the crowded and in warm room. Pulse is rapid, irregular.

Management:

In an acute attack, stop the exercise that the patient is undertaking. Put few drops Amyl nitro-sum 3 on the tongue. There should be immediate relief. Reassure the patient that there is no immediate concern on his condition. Risk factors must be evaluated. Smoking should be stopped. Underlying condition like obesity, thyrotoxicosis and anaemia should be treated. Full history should be taken and regular treatment should be started.

Essay on Cardiovascular Disease # 4. Myocardial Infarction:

Patient presents with history of sudden chest pain, similar in character to exertional angina pectoris, but has occurred at rest and which has remained for quite some time now. There is restlessness, occasional vomiting and sweating. The condition is MYOCARDIAL INFARCTION.

Usually there are no abnormal physical signs unless any complications develop. There may be hypotension initially, and sinus tachycardia may develop. Diabetics, hypertensive and elderly patients have silent myocardial infarction. Myocardial infarctions may go unnoticed or may produce hypotension, breathlessness or arrhythmia.

Investigations to confirm the diagnosis of Myocardial infarction are necessary in order to determine the correct line of treatment.

Increased ESR and polymorph nuclear leucocytosis may occur in the first few days following the MI attack. Necrotic cardiac tissues release cellular enzymes: Creatine kinase (CK), that peaks within 24 hours, and is back to normal in 48 hours.

The size of the infarct determines the total enzyme release, and large infarcts tend to produce higher serum levels of enzyme. Serum glutamic oxaloacetic transaminase (SCOT), now known as Aspartate aminotransferase (AST) peaks at 24-48 hours and may fall within 72 hours to normal.

AST is released by damaged red blood cells, kidney, liver and lungs. Lactic dehydrogenase peaks at 3-4 days and remains elevated till 10-14 days. Enzymes are usually estimated for first three days following a suspected attack. The first assay may be normal but the subsequent will be raised three to more fold rise. ECG is particularly important. The changes are seen in those leads where they face the infarct.

Treatment:

Pain is the primary symptom that may need an immediate attention. Lethal arrhythmia may occur. This needs special care and attention. Therefore it is always advisable to admit the patient to a coronary care unit of hospital as soon as possible. The emergency department must have the staff and facilities to provide the treatment required within the first few hours.

Before the patient is transported to the hospital one can prescribe Morphine 3x-6x in frequent doses. It may take care of that restlessness, hyperesthesia, trembling, twitching and jerking of limbs; the patient becomes extremely susceptible to pain, which is the pathogenesis of this drug.

Arsenic alb:

Is another restless remedy that comes in the picture particularly when there is anxiety and constant fear of death. As the Infarct progresses, it may develop arrhythmia, either bradycardia or tachycardia. Ventricular extra systoles are common. Ventricular fibrillation may follow.

Digitalis:

Is a good heart remedy, where there is slow, irregular and intermittent pulse with dropsy of the internal and external parts? There is weakness and dilatation of the myocardium. The pulse is slow in recumbent posture but irregular and dicrotic in sitting posture.

The greatest indication of Digitalis is when auricular fibrillation has set in and there is failure of compensation. There is coldness of skin, irregular respiration, bluish appearance of the face. There is sudden sensation of stoppage of heart (Opp Gelsimium). F, 3, 30 are commonly used.

Iberis amara:

Has dull or stitching pains, palpitation and breathlessness on slightest exertion. Pains radiate down the left arm and there is irregular pulse. Consciousness of the heart is the characteristic symptom. The pulse is full, irregular and intermittent. Slightest exertion, laugh, cough aggravates the situation.

Wakes up in the morning at 2 a.m. with tachycardia. The concomitant symptom of heat and fullness in the head and neck, vertigo and nausea are very important. The excessive nervous and frightened condition with cold hands and feet frequently found associated with the heart condition is present.

Remedies mentioned under Angina pectoris can also be considered for Myocardial infarct. The death and the necrosis of the myocardial and coronary tissue is checked by these drugs and helps the heart to come back gradually to its normal working condition. Oxygen at 60% is usually given routinely through face mask or nasal cannula for several hours because during the acute attack of MI, the arterial PO2 is reduced.

Management:

Bed rest is essential initially but, if possible, full mobilization should be achieved within a week or ten days to reduce the degree of physical and mental debility inflicted by this illness. Smoking should be stopped. 50% mobility can be allowed in a month’s time depending on the rate of recovery. The patient can return to his normal work after 3 months. Car driving may be prohibited for 6 months.

Essay on Cardiovascular Disease # 5. Acute Rheumatic Fever:

A child or an young adult between the age of 5-15 years, suddenly comes with-fever, fleeting joint pains, mostly the large joints like knee, elbow, ankles and wrist, that are swollen, red and tender; malaise and loss of appetite. The disease is probably ACUTE RHEUMATIC FEVER.

Rheumatic fever is a disease that develops as result of infection with group A Streptococci. It affects the heart, skin, joints, and central nervous system. Pharyngeal infection with group A streptococcus may be followed by the clinical syndrome of Rheumatic fever. Clinically two major manifestations are seen: Cardiac features and non-cardiac features.

Cardiac features manifest as:

New or changed heart murmurs, development of enlargement of the heart or a cardiac failure, development of pericardial effusion with ECG changes (raised ST segment) or myocarditis (inverted or flattened T-waves), a transient diastolic mitral murmur.

Non-cardiac features manifest as:

Fever with excessive tachycardia, a fleeting polyarthritis, Sydenham’s chorea (spasmodic unintentional movements). Erythema marginata. Investigations are necessary to come to a diagnosis. Throat swab culture for A Streptococcus. The anti-streptolysin O titre. Non-specific indicators such as ESR and C reactive protein levels (raised).

Treatment:

Patient with fever, active arthritis or active carditis should be completely rested in bed. When the clinical syndrome has subsided (e.g. no pyrexia, normal pulse rate, normal ESR, normal leucocytic count) only then the patient may be mobilized.

Arsenic alb:

Is useful in a very early stage — the non-cardiac stage — prevails mostly with the fever, with excessive tachycardia, polyarthritic pains. It is invaluable in rheumatism, where the pains are shooting, burning and lancinating; great restlessness, peculiar thirst and extreme prostration. If this phase is not recognized then the cardiac involvement may take place giving symptoms of burning, oppression about the heart with small, feeble and rapid pulse.

Apis mel:

Follows well especially when there is peculiar wax-like appearance of the swollen joint with prostration, fever, but without thirst, together with other concomitants.

Rhus tox:

Is valuable in every form of rheumatism. Its marked modalities point to the field of usefulness. There is pronounced weakness of limbs. Sense of stiffness on first moving the part after rest. Drawing and tearing pain in the limbs during rest. Shining swelling of the joints. Stitching pain in the heart with painful lameness and numbness of left arm.

Arnica is one of the most valuable remedy in particular or muscular rheumatism arising out of traumatism or otherwise. Great prostration and sensitiveness to touch, sore bruised feeling is always present. Violent stitches in the left chest with pain in the inter-costal muscles.

Eupatorium perfoliatum:

Has great soreness of bones and muscles accompanied by perspiration. The pain is deep into the bones with sensation of broken bones. In whatever circumstances it may be present, aggravation is mostly in the morning and on moving.

Dulcamara:

Is very sensitive to cold and damp, this modality runs through this remedy. Changes from hot to cold induces rheumatic trouble. Great oppression of the chest, when breathing, dull shooting as if blows in and about the sides of the chest.

Rhamnus californica:

Has inflammatory rheumatism of joints, swollen and painful, has tendency to metastasis, has profuse sweat, and rheumatic heart.

“The word rheumatism conveys to the mind a general symptomatology of pain that is similar to certain characteristics whether the difficulty be gout, arthritis, inflammatory rheumatism, or any other disease syndrome, acute or chronic, or from whatever underlying cause, affecting certain group of tissues. The first principle of prescribing that the differentiation of the remedies lies not in the differences of the disease entities, but in the differentiation of modalities, and sensations and locations of parts or tissues affected.” H.A. Roborts.

If the patient in non-cardiac features delays in presenting himself to the physician for treatment, the condition may transform to the cardiac state.

Adonis vemalis:

Acts predominantly on heart when it is affected after rheumatism, influenza or nephritis where the muscles of the heart are in a fatty degeneration: Wandering pains. It regulates the pulse and increases the power of contractions, with more urinary secretions.

Useful in rheumatic endocarditis, mitral and aortic regurgitation and arrhythmia. Pre-cordial pain, palpitation, dyspnoea and marked venous engorgement. Also useful in myocarditis. There is not much literature on the use of this drug in potencies but it is mostly used in Mother tincture form.

Cactus grandiflora:

Chief action centers around the heart and circulation. There are constricting pains all over. Constriction as from an iron band, palpitation worse lying on the left side, endocarditis with mitral insufficiency, together with violent rapid action, murmurs, excessive impulse, increased precordial dullness, enlarged ventricles, low blood pressure, arteriosclerosis. Tobacco Heart.

Kalmia latifolia:

Affects the nerves, heart, circulation, a heart, nerve and rheumatic remedy. Heart’s action is tumultuous, rapid and visible, paroxysm of anguish around the heart, fluttering of heart with anxiety, stabbing and sharp shooting pains, radiating to left scapula, palpitation worse while leaning forward. Frequent pulse. Tobacco Heart.

Lithium carb.:

Affects notably head, eyes, heart, small joints and urinary organs. Chronic Rheumatism connected with heart lesion, and uric acid diathesis. Trembling and fluttering in the heart, extending oack, throbbing and dull stitch in the cardiac region, pains in the heart before menses.

Spigelia anthelmintica:

Violent palpitations, audible throbbing of carotids, sticking and compressive pains radiating to throat. Rheumatic carditis, trembling pulse, whole left side is sore. Pulse is intermittent with palpitations weak tremulous irregular.

Whatever is the disease condition. Aconite is thought of only if there is typical restlessness, physical and mental, anxiety, and the complaints are caused by sudden exposure, suppression of sweat after influenza and colds: Stitching pains in the chest, palpitation with anxiety, shortness of breath, oppressed breathing.

Cough is short and hacking — worse at night and after midnight. Pulse is fast, full, hard, tense and bounding.

Apis:

Has palpitation of the heart, heart stitches backward from the apex, and has scanty secretion of the urine. The pulse is hard, small, intermittent, and quick but weak. In fever, skin is dry hot, alternating with gushes of sweat. Thirst-less. Useful when there is effusion.

Arsenic alb.:

There is pre-cordial pain, that radiates to neck, and occiput. Pulse is more rapid in the morning, and there is palpitation with anguish. Difficult breathing great fear of death, extreme restlessness, marked weakness, and lack of vital heat and night aggravation are the characteristics.

Bryonia:

Has typical affections of the serous membrane, dryness all over. Sharp stitching in the chest on coughing. The pulse is full and quick, modalities are important.

Kali carb:

Has violent palpitation, throbbing extends to the tip of the fingers, there is burning in the heart region, and the heart pains extend to the left scapula there is generalized weakness in the heart, limbs, back. Weakness of the intellect is also important. Suited to fleshy people, sensitive to atmospheric changes, to every draft of air, chilly and has a tubercular constitution.

Mercurius solubilis:

Is typical Hahnemann’s anti-syphilitic remedy. Palpitation on slightest exertion, pulse is irregular, quick, strong and intermittent or soft or trembling.

Spigelia:

Is suited to more anaemic, debilitated, rheumatic and scrophulous subjects. Violent palpitations, audible, throbbing of carotids and subclavian arteries. Violent sticking and compressive pains, radiating to throat, army, worse least motion. Pulse is intermittent with palpitation weak tremulous and irregular.

Spongia:

Has rapid and violent palpitation, with dyspnoea, awakened in the middle of the night with pain and suffocation, feels better in resting in horizontal position. There is right heart hypertrophy with asthmatic symptoms. Pulse is frequent, hard, full, or feeble. Sometimes symptoms of valvular insufficiency.

Essay on Cardiovascular Disease # 6. Hypertension:

A middle-aged person with otherwise a normal disposition complains of irritability of mind on slightest provocation, weariness, tiredness or fatigue, mostly towards the evening. At times palpitation and dizziness is also present. Most probably he is suffering from HYPERTENSION.

In majority of cases no cause can be identified, and this form of hypertension is called Primary/Essential Hypertension. Wherever the cause of hypertension can be established, that hypertension is termed as Secondary Hypertension. These cases are generally very small and about less than 10% cases.

There is no single factor that has been found to explain the Essential Hypertension. The increase in blood pressure is due to small increase in cardiac output. This is due to sympathetic over-activity. Later in the disease there is normal cardiac output but increase in peripheral resistance. ‘

Causes of this essential hypertension are numerous but the main ones are Genetic factor. Obesity, Intake of alcohol. Intake of excess of salt and smoking.

Secondary Hypertension should be considered more seriously in patients with blood pressure. Above 80% of patients of this variety are showing causes in the kidney and their function. This is probably because of salt and water retention. Endocrine causes.

Includes Conn’s Syndrome, Pheochromocytoma, Cushing’s Syndrome, Acromegaly, Hyperparathyroidism, Cardiovascular causes, pregnancy pre-eclampsia. Diabetes mellitus and Drugs. The primary rule to treat the hypertension is to identify the cause of the Hypertension in the individual and try to resolve the case.

Hahnemannian pathology classifies Hypertension into four classes in accordance with the Miasmatic break up:

Functional or Psoric Phase; Sycotic Phase; Tubercular or Pseudopsoric Phase; and Syphilitic or Destructive Phase. In the Psoric or the functional phase the levels of blood pressure show constant fluctuation. It is, therefore, also known as Labile Hypertension.

With passage of time and inadequate treatment this may pass into a regular hypertension. When regular appropriate treatment may be required. The main cause of this hypertension is Stress at both the emotional or physical level.

Emotional disturbance such as Excitement, Anger, Anxiety, Worries, Tension, Shock due to financial loss, or loss of dear ones can seriously affect an individual which can result into rise in blood pressure. Pregnancy is a good example of physical stress that may raise the blood pressure.

Physical overwork beyond one’s capacity for a long period, inadequate rest and sleep can also tend to raise the blood pressure. But as soon as these stresses are over there is always a downward trend of blood pressure and they may attain a normal level.

As long as no abnormal physical signs are demonstrable only change in attitude in life or change of life style is needed for normalcy. This can be brought about by counseling.

To get angry, or to get anxious or tensed or develop worries or brooding etc., are inherent traits of the individual which have been built up over many years and even through the hereditary transmissions. We cannot get rid of them totally but we can certainly reduce their intensities through application of appropriate homoeopathic remedies and by counseling.

Treatment:

Like any other case, a full case history and physical examination is essential to determine the cause of the elevated blood pressure. Often these cases are asymptomatic. Or may have mild headaches or occasional epistaxis and inadequate sleep or overwork with irregular eating habits. At times these patients are over-conscientious, or diligent or scrupulous. One needs a great perseverance to handle these persons.

Patient reveals in his history that he is going through some emotional disturbance, grief, or disappointment, has a mild headache towards the evening and cannot concentrate on his work and even has some sleepless nights and has become short-tempered and irritable. He has also turned introvert.

Dwells constantly on the past unpleasant happenings. He wants to be alone and to cry but cannot. At this point wants no consolation. On examination shows tachycardia with elevation of blood pressure. One is reminded of Ignatia and Natrum Murriaticum.

Emotional element interferes with the coordination of functions in Ignatia. Ailments from grief, fright or emotional shocks, disappointments, unhappy love, sighing and sobbing and inward weeping. Oversensitive and nervous and constantly frustrated.

Worse from consolation. This hypersensitive emotional character causes headaches with throbbing and causes the congestive throbbing in the head in spots shifting from place to place, with increase in blood pressure. Anger and humiliation following a heated argument causes nervous disorders and irritability and trembling. Natrum mur is the chronic of Ignatia.

Staphysagria:

Very sensitive, morbidly sensitive, the least word that seems wrong hurts very much, special senses become irritable, cannot tolerate touch, odour, noise that sends the blood surging to the heart and head — causes the blood pressure rise. There is urinary complaint with the emotional state. Frequent desire to pass urine with burning in urethra. When not urinating, a feeling as if the bladder is not empty.

Belladonna:

Has one marked symptom of congestive headache, with throbbing, hot and red face with burning eyes. This may start after a head bath, or a hair-cut that is relieved by tight bandaging. There is rise in systolic pressure with full bounding pulse. The blood pressure returns to normal after the congestion is normal.

Glonoin:

Has sudden and violent irregularities in circulation with sensations of pulsation throughout the body. Hyperaemia of the brain, congestive headaches, mostly due to suppressions of the menses, the shocks in the head are synchronous with the pulse.

Better by elevating head and in open air. There is a characteristic mental condition “loss of sense of location”. Like in Belladonna, exposure to sun, bright light, or working in heat or under gas-light, may also produce this hyperaemia. Slightest touch to the head or weight on the head causes headache.

We have seen the Psoric dimensions of the hypertensive expression caused because of the mental, emotional or physical stress. These Psoric expressions get greatly exaggerated in Tubercular type of hypertension. These changes are highly fluctuating, and may even lead to epistaxis, bleeding from ears, eyes, nose etc.

At times patient may present with these symptoms, in fact these symptoms often work as safety valves. Blood pressure measured at this point may show elevated figures. Immediate attention is therefore required.

Phosphorus:

A tall person, slim and slender, of sanguine temperament, is ideally a tubercular personality. The bleeding here is due to fatty degeneration of tissue, and organs. Phosphorus is chilly and of tubercular diathesis. In tubercular personalities the symptoms are greatly accelerated and may produce cerebral oedema.

Left ventricular failure or renal impairment. Retinal haemorrhages exudates and papilloedema, when present, are diagnostic of malignant hypertension, more and more complications are present and possible at this point.

Lachesis:

Another remedy that is important. Warm-blooded and highly susceptible personality, susceptible to emotions like grief, sorrow, fright, vexation, jealousy and disappointment in love. Being a hot patient always aggravated by hot weather, sun, hot drinks and warm rooms.

Blood rushes to the head with throbbing pains leaving the extremities cold. Pulsation and hammering in the head, bleeding from any part of the body relieves the headache. Often found useful in menopausal complaints. Cardiac difficulty often associated with the headache.

Fagopyrum esculentum:

Is cross and depressed personality, and having inability to fix attention. There is throbbing in all the arteries with irregular pulse, palpitation and oppression. There is bursting headache. The hypertension in Sycotic personality may be caused by the systemic disorders.

The functional labile blood pressures, when unchecked, pass on to the changes in the body’s biochemistry, resulting into changes in the diastolic pressure, either due to atherosclerotic changes in the blood vessels, or in the renal tissues.

Metabolic changes in as Bonn’s syndrome, Pheochromocytoma, Cushing’s syndrome. Acromegaly or Hyperthyroidism or renal changes like chronic glomerulonephritis, chronic atrophic pyelonephritis, and congenital polycystic kidneys are the commonest causes. In fact, it is difficult to say whether the hypertension has caused the renal disease or vice versa.

Hypertension in pregnancy in its early stages is the essential hypertension where-as in later phases it is pre-eclampsia which is accompanied by proteinuria and oedema. Intake of alcohol, certain drugs and smoking may cause hypertension.

Appropriate treatment may have to be instituted depending on the systemic disorder that is present with the hypertension. And finally, in the syphilitic dimension where there is organic damage has taken place, we are reminded of Aurum met.

Aurum met:

It has increased force of circulation, with flushes of heat and followed by perspiration. Forceful beating of the heart, which may be irregular, easily quickened by noise, excitement or contradiction. Extra systoles are common, local pulsations are prominent.

Desire for fresh air but covers the head when aching. It is usually a fatty heart, with hypertrophy associated with renal disease and cirrhosis of the liver in gouty subjects. Along with all this there is always a depressive mind. Because of disappointed love, contradictions, reserved pleasures, and financial losses.

Baryta mur:

Causes vascular degeneration causing hypertension with comparative high systolic pressure and low diastolic pressure. Present with cerebral and cardiac symptoms. There is accelerated heart beats with palpitation, and scarcely perceptible pulse that is irregular.

Management:

Routine investigations of a hypertensive patient should include:

A chest X-ray; ECG; Urine analysis; Fasting blood sugar. Lipid profile; Urea and electrolytes.

A review of the patient’s life-style and diet may suggest modifications of lifestyle that could lead to some reduction in blood pressure.

Weight reduction. Reduction in heavy alcohol consumption. Salt restriction. Regular exercise and meditation — these are the techniques that have shown reduction in blood pressure. An attempt should be made to reduce the stress and anxiety.

Patient should be educated in trying to treat themselves by observing the do’s and don’t s as suggested by the physician. It must be impressed on them that one single attempt at treatment does not cure hypertension. It is a long-drawn process of regular medication, regular check-up and diet. Regular exercise, such as brisk walk for about 3-5 km per day, is equally essential as medical treatment.

Essay on Cardiovascular Disease # 7. Mitral Stenosis:

A patient giving a history of rheumatic fever several decades earlier, recurrent bronchitis and progressively developing severe dyspnoea, productive blood-tinged sputum, and occasionally blood vomiting— frank haemoptysis — lower abdomen and limb severing — the condition is MITRAL STENOSIS.

There will be bilateral cyanotic or dusky pink discoloration over the upper cheeks, at first the pulse is regular but later there is irregular with atrial fibrillation. The apex beat is tapping in character, a diastolic thrill may be present. X-ray shows a small heart with enlarged left atrium. In sinus rhythm ECG shows bifid P wave. This double humped P is seen best in leads II, V3 and V4.

Laurocerasus:

Constriction of the chest, and burning in the chest on inspiration. Dyspnoea with sensation that he is unable to raise the chest walls, and is better lying down. Folds hand over the chest, as if there is some trouble there, worse by exercise. Pulse is weak and variable, slow or irregular. Clutching at heart and palpitation. Coldness is common sensation.

Strophantus:

Chronic nervous palpitation and arrest of breathing. Heart’s action is weak rapid, irregular, due to muscular debility and insufficiency. Stitches and twitches at the apex. Mitral stenosis and regurgitation. The pulse is rapid alternating with slow, weak and irregular.

Violent palpitations. Heart is greatly dilated, pulsation diffused, double mitral bruit, dullness at both the bases of the lungs. Moist rales, expectoration of bright blood, haemoptysis. Use in Mother tincture form.

Mild mitral stenosis may not need any treatment, other than prompt treatment for accompanying bronchitis. Mild dyspnoea can be treated with diuretics like Apocynum and Acetic acid. And if there is beginning of atrial fibrillation then use Digitalis. In case it continues to deteriorate surgical intervention is suggested.

Essay on Cardiovascular Disease # 8. Mitral Regurgitation:

Patient complains of fatigue and lethargy, a sense of palpitation, dyspnoea and develops arthopnoea. And on examination there is atrial fibrillation, having displaced systolic thrill, soft S1 S3 with pan-systolic murmur. The condition is MITRAL REGURGITATION.

Crataegus oxycantha:

Acts on the heart muscles and is an excellent heart tonic. Useful in chronic heart disease with extreme weakness and oppression. Extreme dyspnoea on the slightest extortion incompetent values with valvular murmurs. Oulse is accelerated, irregular, feeble, intermittent. Often there is cardiac dilation. Arteriosclerosis is associated.

Strophanthus

Medorrhinum:

It is a chronic sycotic and hydrogenoid drug. Used usually when there is chronic inflammation of the valve after the rheumatic fever. It is used normally as an inter-current remedy. Valvular diseases of the heart are congenital in nature or produced after the attack of rheumatism. Originally there is compensatory phenomenon and the treatment can help the patient when prescribed on the available signs and symptoms.

But when the compensation fails then the treatment cannot do much to relieve the patient. As the compensation fails the signs and symptoms aggravate and go beyond the scope of medication. Surgical intervention is, therefore, necessary.

Essay on Cardiovascular Disease # 9. Cardiac Dilatation:

The patient complains of dyspnoea on slight exertion, and on examination the position of the apex beat is indefinite, the impulse is diffuse, the first sound is short and sharp, the condition is CARDIAC DILATATION. Here the systolic pump function of right or left ventricles is impaired.

And these enlargements often produce symptoms of congestive cardiac failure. Dyspnoea on exertion is the primary symptom, fatigvie, orthopnoea, paroxysmal nocturnal dyspnoea, and peripheral oedema, palpitations develop in due course. The prognosis of these patients is poor.

Crataegus oxycantha:

Acts on the muscles of the heart, and is an excellent heart tonic. It does not produce any cumulative action. Patient suddenly becomes weak, heart muscles seem flabby, worn out, oppression of the heart with weakness. Cardiac dyspnoea, and dropsy on slight exertion, without increase in the pulse.

The pain is experienced under the clavicle .The heart is dilated with first sound weak. In order to achieve good results five to ten drops of the tincture should be employed over prolonged period.

Digitalis purpurea:

Least movement causes violent palpitation. And sudden sensation as if the heart would stop. Irregular heart, specially if the mitral valve is involved. These cardiac conditions may start after fevers. Hypertrophy of the heart with dilatation. Pulse is weak and quickened by least movement. It is very slow at rest.

Phaseolus:

Heart symptoms are quite pronounced. Irregular and weak pulse, breathing slow. The most important concomitant symptom is that the patient is diabetic. The palpitation is so vigorous that there is always a feeling that death is approaching. Curious feeling in the chest and at that time there is feeble and irregular pulse.

Cactus grandiflorus:

It is a heart tonic, and this remedy benefits large number of weakened and painful hearts, and its keynote is constriction, with pain and numbness in left arm.

Phosphorus:

Is indicated when associated with the respiratory complications such as bronchopneumonia, or pleuritis. There may not be any cure to this enlargement but the distressing symptoms can be removed or reduced, and may stop further damage to the myocardium.

Essay on Cardiovascular Disease # 10. Hypertrophy of Heart:

Apex beat is below its normal position, the impulse forcible and heaving, on auscultation, the first sound is dull and prolonged. This is the HYPERTROPHY OF HEART. Patient does not present any sign and symptom if the hypertrophy is well compensated for the obstruction in the circulation, which has caused the hypertrophy; in fact he is unaware of any cardiac disorder.

The enlargement is rarely in actual practice limited to one chamber of the heart. It is essentially a compensatory process. If the cause is removable then the prognosis is favourable. Actual physical examination of the patient can reveal the status of the heart.

Arnica montana:

Has fatty heart and hypertrophy, mostly due to excessive straining of the heart as in case of athletes — severe pain in the elbow of the left arm, distressing dyspnoea with cardiac distress, the heart muscles are weakened. On the basis of the same modality, Rhustox is also indicated. But has an odd symptom of coldness of the nose.

Aurum met.:

The patient is hypertensive, with valvular lesions of arteriosclerosis. Develops a sensation of heart being stopped for couple of seconds, and restarts with tumultuous action. The pulse is rapid, irregular, and feeble. Bromium has a similar cause as that of Arnica. Here there is hypertrophy due to gymnastics, violent palpitation, worse on lying on the left side. There is nervous palpitation with nausea with headache.

Kalmia lat:

There is anguish around the heart, fluttering of the heart, with anxiety, palpitation is worse on leaning forward. The pulse is slow tremulous. Often we find these are smokers. They have also suffered from rheumatic fever. Worse from sunrise to sunset.

Lithium carb:

It is considered in a case where there is history of chronic rheumatism, associated with the there is history of chronic rheumatism, associated with the cardiac lesions. Whole body feels sore and heavy. Two grand characters about the heart symptoms, worse on bending forward better after urinating, but worst on rising to urinate. Pain in the heart is usually before menses, at times.

Essay on Cardiovascular Disease # 11. Intermittent Claudication:

Patient, usually an elderly, complains of severe cramping-pain or discomfort in the legs while walking which disappears after a short rest, but recurs when the walk is resumed, the condition is INTERMITTENT CLAUDICATION.

Intermittent claudication is caused by the peripheral arteriosclerosis including arterial thrombosis, this is often senile or diabetic. It is caused also by the inflammatory disease of the arteries like thromboangiitis obliterans or infection like sub-acute bacterial endocarditis, tuberculosis, syphilis, typhoid fever, or Polyarteritis nodosa, giant cell arteritis, rheumatoid disease etc.

Intermittent claudication can also take place due to abnormal vasoconstriction — Raynaud’s disease, or due to physical or chemical agents such as trauma, contusion, intravenous fistvila or aneurysm; chilblain, frostbite, trench foot and immersion foot. Phenols, ergot etc. The symptoms will be slightly varying depending on the site of obstruction, inflammation, or degeneration.

Treatment:

With the typical symptoms of Arsenic alb. there is weariness and trembling of the limbs, and associated with the contraction of the limbs. Better by hot application, must move the limbs constantly or walk about. Restless feet.

Secale cornutum:

Has distorted limbs with paralytic condition, numbness and pricking sensation, paralysis develops after spasm, limbs are cold and there are cramps in the calves, gait is dragging. Icy coldness of the limbs. Skin is shriveled, cold, wrinkled, dry or bluish development of slow dry gangrene. Wants parts uncovered.

Cactus grand:

Has constrictive feeling, with acute pain. It is known for its use in aneurysm of large arteries and heart, weakness of the heart with arteriosclerosis. Alternate clutching and release feeling. Constricting pains run through the pathogenesis of this drug.

Management:

Patient should be asked to refrain from smoking and if he has diabetes or hypertension he should control both the conditions. If obese, one should be asked to reduce weight. Limb must be kept warm but no local heat should be applied. Regular exercisers should be suggested for regularizing the circulation by development of anastomosing the vessels.

Essay on Cardiovascular Disease # 12. Superficial Thrombophlebitis:

An elderly patient complains of painful, tender, cord-like structure, associated with redness and swelling, involving long saphenous veins often with varicosities. The condition is SUPERFICIAL THROMBOPHLEBITIS.

Hamamellis:

Has principle action on veins of the rectum, genitals, limbs and throat producing venous congestion and haemorrhage. There is marked soreness of the parts, in fact it is bruised soreness and useful in post-operative care of pain. The haemorrhage is dark.

Vipera berus or (Syn. Vipera torva): in case of phlebitis and varicose veins is “worse on letting the affected limb hang down as if it would burst with fullness”. There is inflammation of the veins with great swelling.

Fluoric acid:

Has characteristic destructive properties and, therefore, causes decay of long bones, ulcerations, bedsores and varicose veins. A remedy of old people with swollen scrotum and varicocele.

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