CARDIAC DISEASES

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CARDIAC DISEASES
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• 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

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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 systems power
  supply.

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Structure of Heart

• Heart valves
• Heart chamber
• Myocardium
• Pericardium
• Endocardium
• Coronary arteries

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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

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Heart Valves
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Myocardium

• Muscle tissue, known as myocardium or cardiac
  muscle, wraps around a scaffolding of tough
  connective tissue to form the walls of the
  hearts chambers

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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.

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Endocardium

• The inner surfaces of the hearts 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 bodys blood vessels, forming one
  continuous lining throughout the circulatory
  system.

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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 arteriesthe right, the left
  circumflex, and the left anterior
  descendingnourish different regions of the heart
  muscle.

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FUNCTION OF THE HEART

• The hearts duties are much broader than
  simply pumping blood continuously throughout
  life. The heart must also respond to changes in
  the bodys demand for oxygen.
• Cardiac cycle
• Heartbeat
• Heart sound
• Cardiac output

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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.

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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.

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• 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

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• 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.

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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.

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Major causes of heart diseases
Emotion
Physical excitement
Fatty diet
Stressful life
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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.

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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.

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• 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

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Arteriosclerosis

• Arteriosclerosis, a group of disorders of the
  arteries, the tubular vessels that carry
  oxygen-carrying blood from the heart to the
  bodys 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 diseases advanced stage, there
  is a risk of a decrease in blood flow and oxygen
  supply to all parts of the body.

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• The most common form of arteriosclerosis is
  atherosclerosis, also known as coronary artery
  disease. In this condition, deposits of plaquea
  material rich in greasy compounds called lipids,
  including cholesterolform on the inner walls of
  the arteries. These deposits narrow the arterial
  channels and partly block the normal flow of
  blood through them.

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• 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 bodys requirements. Unless
  treated, this condition is fatal.

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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
menopause.
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• 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.

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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
one-third have two-vessel disease, and the
remainder have three major vessel disease.
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• 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.

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3. 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.  
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• 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
• Stable or typical angina
• Prinzmetal's variant angina
• Unstable or crescendo angina

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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)

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• 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

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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

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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

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• CLINICAL FEATURES
• The patient is
• Dyspnoeic restless
• Anxious
• Cyanosed profusely sweating
• Respiration is rapid
• Blood pressure is raised

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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

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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

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• 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.

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MANAGEMENT OF CARDIAC DISEASES
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• 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

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• 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

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To understand cardia and cardiac diseases with
Homoeopathy
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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

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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

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APOCYNUM CANNABINUM

• Hydropericardium, hearts 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

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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

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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

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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 hearts action
• Pulse is quick, throbbing, tense and hard
• Endocardial murmurs

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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

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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

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Gelsemium

• Cardiac neurosis with deficient power action
• Dulness,diziness,drowsiness trembling or tremor
• Irregular beating of heart
• Hearts action slow feeble
• Beats cannot be felt

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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

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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

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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

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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

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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

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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

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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

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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

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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

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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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THANK YOU