CARDIAC CARE IN CORONARY HEART DISEASE (HEART ATTACK) FOR ELDER PEOPLES - GENERAL AND HOMOEOPATHIC APPROACH

Cardiovascular disease is the most frequent diagnosis in elderly people and it is the leading cause of death in both men and women older than 65 years of age. The high morbidity and mortality from cardiovascular disease warrant aggressive approaches to prevention and treatment that have been shown to be effective in older patients. Cardiovascular disease is the most important cause of death in both men and women in this age group. More than 80 percent of all deaths attributable to cardiovascular diseases occur in people older than 65 years with approximately 60 percent of deaths in patients older than 75 years old. High blood pressure, heart failure with preserved systolic function and multivessel disease are very common.

The prevalence and severity of Coronary Artery Disease (CAD) increases with age in both men and women. A significant number of people older than the age of 60 years have significant CAD with increasing prevalence of left main or triple-vessel disease. In addition, aging is associated to increased arterial stiffness and increased pulse pressure. There is an increase in fibrinogen, coagulation factors, platelet activity, increase in the levels of plasminogen activator inhibitor, resulting in impaired fibrinolysis. Inflammatory cytokines, endothelial dysfunction potentiate the development of atherosclerosis.

Coronary heart disease (CHD) is a disease in which a waxy substance called plaque (plak) builds up inside the coronary arteries. These arteries supply oxygen-rich blood to heart muscle. Over time, the walls of arteries can become furred up with fatty deposits. This process is known as atherosclerosis and the fatty deposits are called atheroma. If the plaque ruptures, a blood clot can form on its surface. A large blood clot can mostly or completely block blood flow through a coronary artery. Over time, ruptured plaque also hardens and narrows the coronary arteries. Coronary heart disease is a group of diseases that includes: stable angina, unstable angina, myocardial infarction, and sudden coronary death.

RISK FACTORS

Coronary artery disease has a number of well determined risk factors.

Major Risk Factors

·        Unhealthy blood cholesterol levels. This includes high LDL cholesterol (sometimes called “bad” cholesterol) and low HDL cholesterol (sometimes called “good” cholesterol).

·        High blood pressure. Blood pressure is considered high if it stays at or above 140/90 mmHg over time

·        Smoking. Smoking can damage and tighten blood vessels, lead to unhealthy cholesterol levels, and raise blood pressure. Smoking also can limit how much oxygen reaches the body's tissues.

·        Insulin resistance. This condition occurs if the body can't use its own insulin properly. Insulin resistance may lead to diabetes.

·        Diabetes. With this disease, the body's blood sugar level is too high because the body doesn't make enough insulin or doesn't use its insulin properly.

·        Overweight or obesity. The terms “overweight” and “obesity” refer to body weight that’s greater than what is considered healthy for a certain height.

·        Lack of physical activity. Being physically inactive can worsen other risk factors for CHD, such as unhealthy blood cholesterol levels, high blood pressure, diabetes, and overweight or obesity.

·        Unhealthy diet. An unhealthy diet can raise your risk for CHD. Foods that are high in saturated and trans fats, cholesterol, sodium (salt), and sugar can worsen other risk factors for CHD.

·        Older age. Genetic or lifestyle factors cause plaque to build up in  arteries as age. By the time you're middle-aged or older, enough plaque has built up to cause signs or symptoms. In men, the risk for CHD increases after age 45. In women, the risk for CHD increases after age 55.

·        Family history of early heart disease.  Risk increases if father or a brother was diagnosed with CHD before 55 years of age, or if mother or a sister was diagnosed with CHD before 65 years of age.

CLINICAL MANIFESTATION

The most common symptoms is Chest pain and chest discomforts.

Nature of Pain

·        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.

DIAGNOSIS

Diagnosis is made based on  medical and family histories, risk factors for CHD, a physical exam, and the results from tests and procedures like Baseline electrocardiography (ECG), Exercise ECG – Stress test, Exercise radioisotope test (nuclear stress test, myocardial scintigraphy), Echocardiography (including stress echocardiography), Coronary angiography

Intravascular ultrasound, Magnetic resonance imaging (MRI).

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.

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:

Indicated Remedies	Indications
Latrodectus Mactans	A violent precordial pain extending to the axilla and down the arm and forearm to fingers, with numbness of extremity. The left arm feels paralysed. This drug has all the symptoms of angina.
Laurocerasus	It is useful when the patient puts the hand on the heart region which relieves the pain. The cardiac asthma is relieved by lying down.
Lilium Tigrinum	It has a cold feeling about the heart. There is angina pectoris with pain in the right arm.
Lithium Carb	Pain in the heart which is worse before and during urination and better after urination.
Myrtus Communis	Stitching pains in the left breast, running through to shoulder blade. There is a burning sensation in the left chest.
Naja Tripudians	Pains extending to the nape of the neck, left shoulder and arm with anxiety and fear of death. When the pathology is prominent and there are plenty of signs as well as symptoms pointing to an organic lesion, the homeopathic medicine will not be able to cure or reverse the disease process, but will help in preventing further progress and let the patient lead a more comfortable life. Certain homeopathic medicines will then be useful in treating hypertension, ischemic heart disease
Baryta Mur	Indicated in arteriosclerosis when a high systolic pressure with a comparatively low diastolic tension is attended by cerebral and cardiac symptoms. There may also be aneurysms of the heart or the aorta. It is useful in pulmonary hypertension and for bronchial affections of old people with cardiac dilatation.
Crataegus	Medicine that acts on the myocardium and is also useful for myocarditis. The heart is dilated and the first sound is weak. It is known to have a solvent power upon calcareous deposits in the arteries.
Convallaria Majalis	When the ventricles are over distended and dilatation begins and when there is no compensatory hypertrophy and when venous stasis is marked. It is useful for dyspnoea and dropsy with suppression of urine.
Iberis	Cardiac debility after influenza. It controls vascular excitement in hypertrophy with thickening of the heart’s walls. There is a dilatation of the heart.
Lycopus Virginicus	Exophthalmic and toxic goiter causing heart disease. There is also hemoptysis (spitting of blood) due to valvular heart disease. The pulse does not synchronize with the heart (atrial fibrillation). It is also indicated in cardiac asthma.
Strophanthus Hispidus	Drug for exophthalmic goiter. There is anemia with palpitation and breathlessness. It is indicated in mitral and tricuspid valve regurgitation where edema and dropsy have supervened. The heart’s action is weak, rapid, and irregular due to muscular debility and insufficiency.