CARDIAC CARE AND HOMOEOPATHY

 CHEST PAIN? BEWARE!!!! IT MAY OR MAY NOT BE A CARDIAC DISEASE - “CARDIAC CARE AND HOMOEOPATHY”

                                                                                                          

Commonly in our nation, many of us think chest pain as manifestation of cardiovascular disease. Chest pain is a feeling of discomfort and/or pain anywhere in the front part of body between neck and upper part of the abdomen. It can occur in many different mild to life threatening disorders. But Chest pain is not only a common presentation of cardiac disease but can also be a manifestation of: 

-         Disease of the lungs.           

-         Disease of Musculoskeletal System.                    

-         Disease of Gastrointestinal System.

-         Psychological problems.

 CAUSES  OF CARDIAC CHEST PAIN

·        I.H.D (Angina, Myocardial Ischemia, Myocardial Infarction)

·        Aortic / Pulmonary Stenosis. (Valvular diseases)

·        Pericarditis

·        Myocarditis

·        Infective Endocarditis

·        Mitral Valve Prolapse.

·        Dissecting Aneurysm of Aorta (Esp. Descending Aorta)

·        Cardiomyopathy

·        Systemic Hypertension

·        Non coronary causes like Severe Anaemia.

CHARACTERISTIC FEATURES OF CARDIAC CHEST PAIN

ISCHEMIC HEART DISEASE:

·        Site of pain: – Retro sternal. 

·        Character of pain: - heaviness, squeezing, burning, constricting, like a band across the

·        Chest or crushing in nature.

·        Radiation of pain: - It radiates across the chest, both arms and shoulders (More commonly medial aspect of left side) Inter scapular region, Neck, Jaw, Fingers and epigastric region.

·         
Duration of chest pain: –

·        Angina - Few seconds to few minutes.

·        Myocardial ischemia - Few minutes to few hrs.

·        Myocardial infarction – Few hrs to few days.

·        Precipitating Factors: - includes exertion, climbing stairs going uphill, anger,

·        excitement, after heavy meals, cigarette smoking & sudden exposure to cold.

·        It is relieved with rest, Sublingual nitroglycerine or isosorbide dinitrate (stable angina).

·        Unstable angina occurs at any time, even at rest without obvious precipitating factors.

·        Associated symptoms: - Sweating, breathlessness & even circulatory collapse also.

·        “LEVINE’S SIGN” – The patient typically use characteristic hand gestures. Patient may

·        keep his fist clenched or open hand over the pre cordial area.

  

          

IN PERICARDITIS:

·        Pain is constant, not related to exertion, Pricking in nature, sharp in character & localised  to the mid- pericardium.

·        Worse by deep inspiration, cough & postural change.

·        Better on sitting up & leaning forward.

IN AORTIC DISSECTION:

·        Severe tearing pain, either in front or back of chest, due to anatomical relation of descending aorta.

·        Onset is abrupt in nature & pain is due to local pressure.

IN MITRAL VALVE PROLAPSE:

·        Sharp left sided chest pain that is suggestive of a musculoskeletal problem may be a feature of MVP.

CAUSES OF NON CARDIAC CHEST PAIN: 

Respiratory Causes:

·        Lung / Pleura causes             

·        Viral etiology

·        Tubercular etiology.

·        Pleurisy

·        Pneumonia

·        Cystic fibrosis

·        Empyema

·        Pneumothorax

·        Lung abscess & Subphrenic abscess.

·        Pulmonary infarction

·        Bronchiectasis

·        Bronchogenic carcinoma

Musculoskeletal causes:

·        Fracture Ribs.

·        Vertebral collapse

·        Costochondritis

·        Myositis of pectoral muscle (myalgia)

GIT Causes:

·        Oesophagitis

·        Oesophageal spasm (achalasia)

·        Mallory Weiss syndrome

·        Peptic ulcer

Neurocutaneous causes:

·        Herpes zoster (shingles).

Psychological causes

·        Emotional distress.

CHARACTERISTIC FEATURES OF NON CARDIAC CHEST PAIN

PLEURITIC PAIN:

·        Location: Any part of rib cage.

·        Localised, Superficial, Pricking or stitching type of pain.

·        Increased with deep inspiration, coughing, laughing, and sneezing.

·        Associated with added sounds & cough.

MUSCULOSKELETAL PAIN:

·        This is a common problem that is very variable in site and intensity but does not usually fall in to any of the patterns described above.

·        The pain may vary with postures & movement of the upper body & is sometimes accompanied by local tenderness over a rib or costal cartilage.

GASTRIC PAIN:

·        Gastric pain can mimic like that of angina very closely.

·        Burning sensation behind the sternum, followed by mild indigestion & vomiting.  Patient may notice acid in the mouth.

·        Pain after eating or drinking with esophageal reflex, & the pain it often radiates to back.

NEUROCUTANEOUS PAIN:    

·        Pain of shingles start before the onset of eruption. (Pre herpetic neuralgia)

·        Pain along line of ribs on one side.

·        Small vesicles appear along the affected segment, respiration will be painful.

PAIN IN PSYCHOLOGICAL PROBLEMS:

·        Emotional distress is a very common cause of atypical chest pain.

·        Diagnosis should be considered if there is a feature of Anxiety or Neurosis, particularly when there is a H/O death of a close friend or relative due to heart attack. (Fear of Heart Attack)

Ø   Easier Difference between Ischemic Cardiac Pain (Heart attack) & Non cardiac pain :

	Ischemic Cardiac Pain	Non Cardiac Pain
Location	Central, diffuse	Peripheral, localized
Radiation	Jaw/neck/shoulder/arm (occasionally back)	Other or no radiation
Character	Tight, squeezing, choking	Sharp, stabbing, catching
Precipitation	By exertion and/or emotion	Spontaneous, not related to exertion, provoked by posture, respiration or palpation
Relieving Factors	Rest, quick response to nitrates	Not relieved by rest, slow or no response to nitrate
Associated Features	Breathlessness, sweating	Respiratory, GIT, Locomotors or psychological

Important General Investigation for Diagnosis

·        Complete blood count

·         X-ray chest

·         Electrocardiogram

·         Lung scan

·         Coronary angiography

GENERAL MANAGEMENT

Steps to Ease Sudden Chest Pain

Chest pain can be the result of a variety of reasons, many of which are small and harmless. However, it can cause sudden discomfort. It is possible to reduce or eliminate chest pain without the use of strong medicines.

·     If the chest pain is severe, long-lasting, or much unexpected, call your local emergency number or go to the emergency room. A lot of damage caused by heart attacks can be reduced if the heart attack is caught soon enough.

·     Eat plenty of healthy foods and get in at least thirty to sixty minutes of exercise per day. Avoid too much stress and handle everything in a calm manner. Eat slowly, as swallowing air can cause chest pain.

·     Breathe in and out slowly. Breathe in through your nose and out through your mouth. Do this at a steady but comfortable pace.

·     Generally, activities like reading, going on the computer or watching TV while having chest pain don't tend to be relaxing, so avoid them.

·     Drink a mild herbal tea, such as mint or chamomile. It will help soothe you.

·     Lie down and relax. Stop thinking too intensely about anything. You may close your eyes, if it helps and try meditating. Have someone talk to you, but remember that loud sounds can only hurt more.

·     Fresh air can be a natural remedy to many ailments. Go for a simple walk, or just sit down if you feel frail.

·     Have someone give you a strong back massage. The effect can carry on to your pain and reduce it.

·     Don't breathe in too hard or too fast. This will only speed up your heart rate.

·     Lay on your back with your hands above your head. This will open your lungs and get more air in.

Preventive measures for cardiac attacks in day to day life:

·     Restrict sodium intake.

·     Avoid foods high in trans fatty acids and saturated fats.

·     Eat a well-balanced, high-fiber diet based on whole grains, legumes, fruits, and vegetables.

·     Eliminate the consumption of refined foods.  

·     Avoid milk, butter, margarine, vegetable shortening, cheese, red meat, and chicken skin. They cause bloodclogging.

·     Blueberries have antioxidant properties. Add them to your morning cereals.

·     Eat fish, especially salmon and mackerel, three times a week.

·     Garlic helps reduce high blood pressure and cholesterol. Take a tiny piece of garlic and crush it with a knife. Swallow with a glass of water.

·     Ginger helps maintain healthy cholesterol levels.

·     Have a glass of red wine with your meal, at dinner.

·     Lose weight, if you are overweight.

·     Avoid overeating and eating late.

·     Engage in 30 minutes of physical exercise.

·     Stop smoking.

·     Avoid stress. 

Home Management

v If u r alone………

And suddenly get Chest pain………

That radiates to your Left arm up to your jaw…….

Then it may be a heart attack!! 

If No one to help you & the Hospital is so far, then don’t wait……..

Help yourself.

§  Cough repeatedly & vigorously.

§  Take deep breath before every cough.

§  Coughing keeps blood circulation Alive…..

§  Deep Breath gets oxygen to lungs…….

v Lower your chance of Heart diseases by laugh. Laugh as much as u can….

v 1 Glass of water before u sleep will help avoid Stroke or Heart attack at midnight.

Natural Supplements for Prevention of Heart diseases

·        Coenzyme Q10 improves heart function.

·        Vitamin C serves as a healing action in the body.

·        Vitamin E helps prevent the formation of blood clots which leads to a heart attack.

·        Magnesium helps improve healing after a heart attack.

·        Policosanol helps the liver produce less cholesterol.

·        Probiotics prevent diseases and maintain good health.

·        EPA/DHA lowers the risk of a heart attack and stroke.

·        Fish oil supplement helps reduce the risk of cardiovascular disease.

·        Vitamin B complex helps prevent a heart attack.

·        Gugulipid prevents plaque formation on arterial walls.

·        Niacin lowers cholesterol in the blood.

·        Potassium may help control heartbeat.

HOMOEOPATHIC MANAGEMENT

In Homoeopathy, medicines are highly individualized to the patient and this will help a state of complete health can be regained by removing all the sign and symptoms from which a patient is suffering. The aim of homeopathy is not only to treat chest pain, but to address its underlying cause and individual susceptibility of the patient. For this patient’s current symptoms, past medical history and family history are taken into account. There are many homoeopathic remedies which cover the symptoms of chest pain and can be selected on the basis of cause, location, sensation, modalities and extension of the pain. For individualized remedy selection and treatment of chest pain, the patient should consult a qualified homeopathic doctor in person. In medical emergencies like myocardial infarction and pulmonary embolism, immediate hospitalization is usually required. Some important remedies are given below for the treatment of chest pain:

Arnica mont. – Chest pain with sore and bruised feeling.

Actea racemosa  – Pain worse on the right side.

Aconite – Chest pain due to pneumonia of first stage along with anxiety and restlessness.

Aurum metallicum treats myocardial weakness. The chest pain is aggravated at night. A sensation as if the heartbeat will cease.

Baryta carbonica is indicated for a senile heart, atherosclerosis, hypertension, and loss of memory.

Bryonia – Chest pain is of stitching, burning and stabbing in nature, is worse by motion and better by rest and pressure. Thirst for large quantities of water and dryness of mucous membranes often accompanies.

Craetaegus oxyacantha is a tonic for the heart. It treats coronary insufficiency. The pulse is rapid and visible. The pain on the left side of the chest radiates to the left arm.

Carbo vegetabilis is indicated for heart failure with cyanosis. Chest pain from indigestion, flatulance and acidity.

Digitalis treats cardiac muscle failure. There is a slow pulse, a tight heart, palpitation, the sensation as if suffocating, and all symptoms are aggravated sleeping on left side.

Glonoinum treats hypertension, atherosclerosis, and all heart conditions aggravated in the heat of the sun.

Kali carb – Stitching pain in the chest, which gets worse between 2-3 A.M

Kalmia treats bradycardia accompanied by rheumatism or gout.

Latrodectus treats precordial pain, the pain intensifies with breathing.

Laurocerasus is indicated for heart failure.

Naja treats angina pectoris. The chest pains radiates towards the nape of neck to the left upper shoulder, and arm.

Platina relieves spasmodic contraction of the muscle around the heart.

Plumbum album is indicated for hypertension, sclerosis, and loss of memory.

Phosphorus – Violent tickling cough, chest pain due to tuberculosis of lungs or pneumonia along with oppression of the chest.

Robinia – Burning pain behind sternum due to hyperacidity.

Ranunculus b. – Good remedy for intercostal rheumatism, sharp stitching pain in the chest along with dyspnoea.

Rhus tox. – Pains extend to the shoulders, worse by initial motion and cold-damp weather, better continued motion and warmth.

Rumex c. – Sharp stitching pain through the left lung, often with cough.

Stannum – Knife like stitches, worse on bending forward and left side.

Spigelia relieves violent cardiac palpitations with shooting pain in the breast area. An inability to sleep, worse sleeping on the left side.

Strophantus is indicated if there is suspicion of a heart attack. The degeneration

of the cardiac muscle accompanied by irregular heartbeat. The pulse rate is rapid

at times and slow at other times.

Tabacum treats hypertrophy of the heart.

Veratum album calms cardiac palpitations.

Viscum album treats hypertrophy of the heart.

Mind - FEAR, general, phobias - heart, disease of:

acon. arg-n. Arn. Aur. bapt. cact. Calc. calc-p. daph. hed. hydrog. KALI-AR. lac-c. lach. Lil-t. lob. Med. nat-m. nux-m. PHOS. sars. sin-n. Spong.