Clinical Cases

A Case of Atrial Septal Defect (ASD)

Muhammad Afzal
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Dr. Muhammad Afzal Sandhu presents a case of a two year old girl with an Atrial Septal Defect.

An atrial septal defect (ASD) is a congenital defect of the heart in which there is a hole in the wall (septum) that divides the upper chambers (atria) of the heart. A hole can vary in size and may close on its own during infancy or may require surgery.

During pregnency, the fetus’s blood does not need to go to the lungs to get oxygenated. The ductus arteriosus is a hole that allows the blood to skip the circulation to the lungs. However, when the baby is born, the blood must receive oxygen in the lungs and this hole is supposed to close. If the ductus arteriosus is still open (or patent) the blood may skip this necessary step of circulation. The open hole is called the patent ductus arteriosus.

During uterine life, normally there are several openings in the atrial septum of the fetus which allow pulmonary venous return from the left atrium to pass directly to the right atrium. These holes usually close during pregnancy or shortly after birth. If one of these openings does not close, some oxygenated blood from the left atrium flows through the hole in the septum into the right atrium, where it mixes with oxygen-poor blood and increases the total amount of blood that flows toward the lungs. This can result in a spectrum of disease from no significant cardiac sequelae to right-sided volume overload, pulmonary arterial hypertension, and even atrial arrhythmias, depending on the size of the defect, size of the shunt, and associated anomalies.

Most Common Types Of ASD

  1. Ostium secundum: The most common type of ASD accounting for 75% of all ASD cases.
  2. Ostium primum: The second most common type of ASD accounts for 15-20% of all ASDs.
  3. Sinus venosus: The least common of the three, sinus venosus (SV) ASD is seen in 5-10% of all ASDs.

Signs and Symptoms

  • Shortness of breath, especially when exercising
  • Fatigue
  • Swelling of legs, feet or abdomen
  • Heart palpitations or skipped beats
  • Frequent lung infections
  • Stroke
  • Heart murmur – a whooshing sound that can be heard through a stethoscope.

Case Presentation

Samreen, female, age 2 years was suffering from an atrial septal defect with moderate patent ductus arteriosus (PDA). She was advised surgery by the heart surgeon but her mother feared surgery so she visited my clinic on August 15, 2010. Patient’s echo cardiogram showed;

  • Large high secundum arterial septal defect
  • Moderate patent ductus arteriosus (PDA)
  • Severe pulmonary hypertension
  • Severe tricuspid regurgitation (TR)

The patient was on allopathic medicine and couldn’t manage without it, so her mother was advised to give the medicine along homeopathic remedies.

Complaints presenting at the time of consultation

  • Shortness of breath (dyspnea) when she was trying to run during play or walking rapidly.
  • Easily fatigued on least exertion.
  • Rapid heart palpitations.
  • Each winter she experienced severe long lasting frequent chest infections with fever.
  • She had dry skin with small cracks and eruptions, appeared in winter.
  • White dandruff
  • She can’t cover her body especially her face, even in winter.
  • She likes chilled cold drinks, ice cream and salted foods.

PHYSICAL GENERALS

Appetite    : Diminished

Thirst       : Excessive during an acute infection

Desires        : cold drinks

Bowel Habits  : Normal

Urination    : Normal

Perspiration    : on exertion/running

Sleep     : Normal

Thermal reaction: Hot patient

 PHYSICAL EXAMINATION

  • A protruding thin chest
  • Weak body with pale skin

May 2016 Muhammad Afzal Sandhu

 Selection of Remedies

The following remedies were administered during whole span of treatment according to the symptoms;

  • Phosphorus 30, 200
  • Sulfur 200
  • Calc phos 6x

RESULTS

Treatment went on for about 12 months. Treatment started on August 15, 2010 with a single dose of Phosphorus 30 (weekly one dose for a few weeks) followed by placebo.  After 3 weeks her mother seemed satisfied as she observed there was less breathlessness when playing with her age friends. Now repetition of dose was reduced by increasing gap. Calc phos 6x was used to tone up general physical condition as literature described5 that it can be alternated with phosphorus in exhaustion with nervous weakness. Sulfur 200 one dose needed as during an attack of chest infection. One dose of Phosphorus 200 applied during last month of treatment period.

DISCUSSIONS & CONCLUSIONS

Phosphorus is a deep acting, constitutional remedy commonly used with various chronic ailments. Its pathogenesis shows a broad sphere of action including viral hepatitis, pneumopathy, cardiopathy, severe infectious syndrome etc3. In this case, its application on the basis of similia offered good results within a short time. There was a prominent change in shortness of breath. She started to enjoy playing. The allopathic drugs used for her cardiac and associated problems were discontinued.  During the winter she had nominal attacks of chest infection as well as skin eruptions. Complementary use of Calc phos 6x boosted her energy level and she displayed a good complexion.

After one year of treatment an echocardiogram was done, which revealed some level of good changes in heart anomalies. The cardiologist advised that there were good changes that but surgery might be required. Her parents did not tell the doctor about homeopathic treatment due to fear of opposition to homeopathy. The parents were told to seek surgery by the cardiologist, but due to their financial  circumstances couldn’t afford it.  Four years after stopping the homeopathic treatment, the young girl is still enjoying life with no medicine and no surgery. Here I would like to add a comparison of 2 reports.

First ReportLast Report
Large high secundum arterial septal defect

 

Large high secundum arterial septal defect

 

Moderate patent ductus arteriosus (PDA)

 

Tiny patent ductus arteriosus (PDA)

 

Severe pulmonary hypertension

 

Moderate to Mild pulmonary hypertension

 

Severe tricuspid regurgitation (TR)

 

Not Mentioned

These results show the potential of homeopathic treatment in cardiac problems. It is time to do research in this specialty as homeopathy is considered the last hope by many patients.

May 2016 Muhammad Afzal Sandhu.

May 2016 Muhammad Afzal Sandhu,

REFERENCES

  1. Bonow RO, Mann DL, Zipes DP, Libby P, Braunwald E, eds (2011). Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine.9th ed. St. Louis, MO: WB Saunders:chap 65.
  2. Constantinescu T, Magda SL, Niculescu R, et al (2013) New Echocardiographic Tehniques in Pulmonary Arterial Hypertension vs. Right Heart Catheterization – A Pilot Study.Maedica (Buchar). Jun. 8(2):116-23.
  3. Guermonprez M, Pinkas M and Torck M (1989) Matiere Medicate Homeopathique, Editions Boiron.
  4. Hanslik A, Pospisil U, Salzer-Muhar U, Greber-Platzer S, Male C (2006) Predictors of spontaneous closure of isolated secundum atrial septal defect in children: a longitudinal study. 118(4):1560-1565.
  5. Rehman A (2005) Encyclopedia in remedy relationships in homeopathy, Thieme, Stuttgart, New York.

http://kidshealth.org/en/parents/asd.html

http://www.cdc.gov/ncbddd/heartdefects/atrialseptaldefect.html

https://www.nlm.nih.gov/medlineplus/ency/article/000157.htm

 

About the author

Muhammad Afzal

Muhammad Afzal

Dr. Muhammad Afzal Sandhu received his BHMS from Islamia University Bahawalpur and a DHMS from Anwarul Islam Homeopathic Medical College Kasur. He’s been in homeopathic practice for fourteen years. He is also trained in microbiology (Univ of Lahore- Pakistan) and advanced acupuncture (Beijing China). He’s worked five years teaching anatomy, physiology, microbiology and materia medica. He is currently working with the Fauji Foundation- Lahore, as a homeopathic medical officer.

Leave a Comment

6 Comments

  • Dear Dr. Muhammad Afzal Sandhu Sb,
    As usual, a wonderful explanation and presentation of case with supporting documents and proper references. Thanks a lot for sharing it with us.
    Great Work!

    Regards,
    Hussain Kaisrani
    Bahria Homeopathic Clinic
    Safari Villas, Bahria Town Lahore

  • Well managed but ASD can be cured and we have done upto 26mm size. PAH can be reversed within few weeks. Add anti miasmatic drug with some more powerful heart affectionated remedies for better results. Good luck!

  • Dear.Dr.Muhammad Afzal. A wonderful explanation of case with supporting documents and proper references. Thanks a lot !Great work ! All the best !