A male patient, 60 years of age, was a known case of Ischaemic Heart Disease (a damaged heart with poor cardiac circulation due to multiple vessel blocks), Diabetes Mellitus and Hypertension. He was an architect by profession. He was admitted into a well known Mumbai Hospital (Nanavati Hospital, Villeparle) with with acute cardiac angina under the care of a Cardiac Surgeon. This was the second episode he had had in 6 months. Along with pain, the symptoms of this episode were perspiration and dyspnoea on exertion. He had been diagnosed with Acute Myocardial Infarction in Congestive Cardiac Failure along with Arrhythmia.
ECG showed global Myocardial Infarct with Atrial Fibrillation
Echo Doppler Study showed an Ejection Fraction of 20%
Haemoglobin of 8.9 gms%
Blood Pressure: 100 Systolic
Heart rate: 150 per minute
PAP (Pulmonary Arterial Pressure) : 40
Angiography: Shows Tripple Vessel Disease
Kellipie’s Classification: grade IV, Survival chances 10%
Past treatment given:
Poor response to thrombolytics which enhanced Myocardial Depression and Cardiogenic Shock. He was already on Nitroglycerine and antiarrythmic agents but showed inadequate response to them. The arrhythmia failed to revert.
As a last resort, an intra-aortic balloon pump was advised to maintain the coronary blood flow as well as maintain his systolic pressure.
The cardiac surgeon had suggested a by- pass and was prepared to do it once the arrhythmia reverted and the blood pressure stabilized. The other option was to manage conservatively with a poor chance of survival, less than 10%. But he kept getting attacks of cardiac angina with arrhythmia. His general condition was very poor and he was constantly exhausted. In view of the recurring post infarct angina and cardiogenic shock with arrhythmia the cardiac surgeon refused to take him up for surgery.
Since the conventional line of treatment was not proving effective, the family requested that the cardiac surgeon consult the Homeopath. The idea was that the homeopathic treatment would stop the angina and revert the arrhythmia so that the patient could be taken up for surgery once he was stable. Initially the surgeon was reluctant to do so as he was keen to follow his own protocol of functioning. But it so happened that the pateint developed a second episode of acute angina with arrhythmia and it seemed like he would die anytime.
At this point, the surgeon himself decided to bypass traditional protocol and invite the homeopath for an assessement and possible treatment. He asked the relatives to call me in and was ready to give me whatever help needed. He cautioned me, however, that a long, detailed history and interaction with the patient would be impossible in such circumstances.
What does a homeopath do in such circumstances? Hahnemann in his wisdom has given us ALL instructions for this in the Organon – check the section on case taking especially Aphorisms #84 and #92. My first source of information was the cardiac surgeon himself!
He explained to me how the patient behaved during angiography. He explained that the patient was extremely childlike in his behavior and very uncooperative. He was extremely afraid and seemed sure that he would die. He kept asking whether everything was going to be alright and if he was OK. With this high level of anxiety, right during the angioplasty procedure he developed an acute angiospasm which was recorded on the angiography. The patient refused to go forward with the angioplasty. the procedures were stopped and he was brought back to the ICCU. This was an important component of the history supplied by the Allopathic MD.
Patient as a Person from the Attendants/Relatives:
The next important information we gathered was from the family. We were able to understand more about him as a person. It appeared that he was a very conscientious person by nature. He was meticulous and cautious in everything he did. He was hardworking and was a self made man.
At some point he got into a conflict with his father and he decided to leave the home. He married and had a son. Later, he developed a conflict with his son and decided to live separately following this. They described him as harsh and critical in his judgments. He was an achiever and always pushed himself further than his capacity. On a positive note, he was sentimental in his relationships with others and seems to want to maintain them. He liked to help a good cause in his own way and did so. He wanted to maintain a clean slate in all his dealings and avoided making decisions that would result in any ‘blemishes’. He was afraid of spoiling his reputation.
Our time with the patient in the ICCU was limited to about 10 minutes of observation. This was the second episode of Cardiac Angina with Arrhythmia and he was in almost a dying state of cardiogenic shock. While we were watching him, he told the attending doctor that there was nothing wrong with him and he was going to get back to work! He denied that he was afraid and said that he was fine. Then suddenly he stated; “My mother died in the opposite bed in the same hospital.”
He also said that the present complaint was pain in the left chest which he also felt in the back. He constantly denied feeling afraid but still wanted someone near him all the same. He did not want to be left alone. The only thing he was willing to admit was that he was not sure if he was in safe hands, he could not trust the doctors to care for him and manage his case.
In addition we observed:
He kept his right hand on his left chest, near the heart constantly. He never removed it from there all the time we were with him. He talked with an expressionless, depressed face. He had fear in his eyes and he had an exhausted look about him.
We now have to decide on what the focus of our prescription is. Here we have an acute expression of advanced pathology. He could die without surgical help. We need to be clear from our homeopathic philosophical perspective what the pathogenesis of his disease has been and what the susceptibility of the vital force is capable of receiving. This is so that we understand the “quality” or “level” of homeopathic stimulus required to begin the journey towards cure. We perceive that there is a possibility along with surgical intervention that this case can be healed (rather than palliated on homeopathic treatment. Some of the destruction is reversible as long as adequate blood flow to the heart is revived with a bypass surgery.
For this stage of pathological expression it would be a mistake to give the constitutional remedy. An aggravation could result in death. The vital force is not strong enough. What it needs is a specific stimulus that will allow a vital organ like the heart to get back on its “feet” again. For this we have to focus on the expression of the heart symptoms and the disease pathogenesis that affects the other organs of the body directly or indirectly, emotionally or physically. This is a depth and perception that requires a certain amount of training. Dr. C.M. Boger was one of the pioneering homeopaths with a medical background to present this depth of perception.
Armed with all this information we came up the the following characteristic picture:
His current Totality showed:
Fear of death, heart symptoms during
Fear of failure
Occupation, desire for
Mistrust of his surroundings – feels they will harm him
Holds hands over the heart
Developed a Cardiac murmur as the Chordae tendinae were destroyed.
(This is the pathology that was the cause of the heart murmur: the destruction of certain “chords” within the heart chambers that interfered with the proper functioning of the valves of the heart and hence causing a murmuring sound.)
INDICATED REMEDY with follow up:
Based on the perception of the pathogenesis as well as the acute picture as explained above, Naja 200 C, ONE single dose was prescribed.
Twenty minutes after the Only dose of Naja, the arrhythmia reverted
Blood pressure picked up and so did PAP. More details about Pulmonary Arterial Pressure monitoring can be seen here:
He continued to improve steadily and was able to be taken up for a by pass surgery. Post by pass within 24 hours the patient again developed an arrhythmia which was again resistant to the conventional treatment. This time the cardiac surgeon himself prescribed Naja 200 c single dose! It was 35 minutes before the arrhythmia reverted.
Later we followed him up with his constitutional remedy which worked out to be Aurum Ars. Due to the low to medium susceptibility, we gave him a 30C in infrequent doses. Now he is doing fine, he actually has been able to return back to work and also travels regularly.
Homeopathy through the similimum remedy works in every indicated situation, the acute, the chronic or the emergency. What is required of the homeopath is a sound knowledge of disease, a sound knowledge of the remedies, and a trained and accurate power of observation. Essential to hold this all together is a strong sense of trust and commitment to the principles of homeopathy laid down in the Organon and a strong inclination for hard work.
In addition we see in this case, the cooperation and conversion of the Cardiac Surgeon. We do not need to use any other method of argument to convince our colleagues, the MD’s of conventional medicine that homeopathy works. They are capable of observing the action of healing provided the correct similimum has been prescribed. We have one more MD into the homeopathic fold, following the wonderful healing in this case. We can strive to do just this as we evolve ourselves into better homeopaths.
Click here for a SLIDE SHOW on this case.
Below are some general expressions of Naja from Boger’s Synoptic Key to get a comprehensive idea of the Scope and Pathogenesis of the remedy in acute Cardiac conditions:
NERVES HEART (Mitral Valve.)
Left side Ovary.
Left side temple
Left side arm.
WORSE lying on left side.
WORSE after sleep.
WORSE after menses.
WORSE air cold.
WORSE air drafts
WORSE pressure of clothes
BETTER riding in open air.
Nervous, excited and tremulous, with cardiac effects, often reflex.
Parts seem drawn together. constrictions, throat, chest, etc.
Insensible right side.
Shootings in head.
As of a blow on occiput and neck.
Vertex sensitive to cold.
As of a lump in throat.
PAIN FROM LEFT OVARY TO HEART.
Suffocative Choking, grasps the throat.
Cardiac asthma or cough.
HEART: weakness at violent pain, shooting to left scapula. shoulder or neck, cramp ascends into neck, holds hand over it, excited, tremendous action, palpitation, visible, hypertrophy, endocarditis, septic.
Dry or empty in left lung.
Ribs feel broken.
Cramps in shoulder, nape or thigh.
Numb left arm.
Terrifying racking in marrow of thigh.
Puffy or sweating hand and feet.
Pulse changes force.
Internal heat, aggravation chest.
Sweat on lumbar back and ankles.
Related: Cimi. Lachesis Laur. Spigelia
Dr. Navin Pawaskar, BHMS
Assistant Director – Clinical Services and In-Charge Emergency Services at
Dr. M.L. Dhawle Memorial Trust’s Rural Homeopathic Hospital,
Opp S.T. Workshop
Palghar – Boisar Road, Palghar 401 404
PH: (02525) 256932, 256933