- Cardiology as a Specialization in Homeopathy
- Pursuing Cardiac Management with Homeopathy
- What is a realistic expectation of Homeopathic treatment in Cardiac Patients?
- Post Acute Stage Management
- Anatomy And Pathophysiology
- Introduction Homeopathy as a science and art is still developing, and we as homeopaths are also developing our skills. We are clearly aware that we can treat much more than coughs and colds and skin ailments – yes, we can treat emergencies, we can treat cancer, we can treat cardiac ailments as well. But we’re all still on the learning curve of management and protocol, to be effective and consistent at the clinical level. How much do we need of the hospital structure and functioning that already exists? Our colleagues of modern medicine are very advanced in their emergency management of cardiac conditions with clear text book protocols and triage in place. That, my friends, depends on one’s perspective.
If a patient feels more comfortable in the environment of the hospital, then treat him in the environment of a hospital with whatever supportive treatment measures are available and compatible with homeopathic medication. Often we may need to allow our colleagues to take first action and then simply complement with what we can do (better).
But, if a patient is comfortable to be treated at home and prefers to be home – there is where homeopathy can triumph. Yes there are a good percentage of people who would like to avoid the expense and the trauma of hospitalization and prefer to be treated at home, while we keep track of all the symptomatic and lab parameters that indicate improvement or deterioration.
Ultimately it remains the patient’s choice! I have treated patients of both types and have had success in both situations. The secret of homeopathic management is to make sure you have given the patient a good constitutional remedy or at least a deep acting phase remedy that is taking them in the direction of Hering’s Law of cure. That forms the fundamental foundation of all treatment ups and downs along the way. The case illustrated will explain this.
II Cardiology as a Specialization in Homeopathy
Why would someone with a cardiac ailment want to take homeopathy? This is the first question we should ask ourselves as homeopaths. Often the answers are not encouraging. Cardiac conditions are considered to be life threatening or serious – not something one can ‘try out’ with homeopathy – and that is a fact. So, it is important for those who wish to treat cardiac conditions with homeopathy, to first have a sound knowledge of various cardiac presentations and understand what requires immediate treatment (allopathic or homeopathic) and what can be treated on a long term basis.
In the first instance, conditions like Acute Coronary Syndrome (ACS), Myocardial Ischaemia and Malignant Hypertension need to be treated on an emergency basis and one needs to make quick decisions on what line of treatment is favorable for the patient, given the available time and clinical presentation. These are clinical decisions that come with experience but are crucial to success. Modern medicine, as stated earlier, keeping in mind the morbidity and unpredictability of these situations, has developed protocol and triage management of cardiac emergencies to a very efficient level. For a homeopath to match that efficiency requires not only good knowledge and perception of the case, but calm nerves and self confidence as well. This does not mean that homeopathic remedies are not reliable in such situations. We do have an ample number of homeopathic cardiac remedies for each of these conditions and a good homeopathic cardiologist would be expected to know these remedies on his or her finger tips. Luckily today we have good software to assist the memory and case analysis for quick diagnosis and choice of a remedy. Yes we will get there eventually as homeopathic cardiologists – but obviously – Homeopathic Cardiology is in its infancy, though definitely on its way to being a good option especially for people who seek alternative treatment rather than modern drugs.
III Pursuing Cardiac Management with Homeopathy
So where do we start?
- First, by recognizing what is to be treated and how, in a cardiac condition. The first question we ask ourselves – Is this an emergency condition? Pulse, blood pressure and presentation of symptoms need to be regarded with a high degree of suspicion for life threatening cardiac related symptoms.
- With quick questioning and helpful emergency lab parameters like- ECG, blood sugar level, cardiac triage (levels of certain enzymes in the blood like Troponin 1, BNP, CPK MB), oxygen saturation, one can know whether the patient needs immediate intensive care or can be watched for a developing condition. A past history of Diabetes, Dyslipedemia, Renal pathology, Hypertension and a family history of cardiac problems all point to a higher possibility of cardiac pathology.
- Once cardiac pathology is established – emergency treatment is started based on observations of the acute symptom presentation. One needs to be certain of obtaining a positive healing response within the space of the next 10 to 15 minutes. … if not, the remedy may not be similar and the next appropriate remedy needs to be given. So we need to be wise about what parameters we’re expecting an early change in – mostly subjective characteristics and clinical symptoms – and keep a watch on them.
- Once the remedy is simillimum and the clinical state has definitely begun to improve, however subtle – one needs to decide on the frequency of dosage. Often the requirement may be as often as every 5 minutes in water doses, and then tapered off to a less frequent repetition as the patient becomes more comfortable… to a 3-4 hourly dosage.
- The next step in management is to evaluate what other supportive acute remedy the patient needs by observing the change in symptom picture, which symptoms are not resolved and if any new symptoms have come up. In a good percentage of cases, if the previous remedy has not made any change in these symptoms, it usually indicates another remedy that needs to be given in tandem. These are cases with complicated pathology and lab parameters. One cannot expect a ‘single remedy/ single dose’ concept to have adequate curative effect and healing response during the emergency phase. We can understand this better only once we take the complete detailed history.
- So that is the next stage of management, to take the complete detailed history of the patient so as to understand the miasmatic background of that particular individual, to determine what complications one would expect during treatment and also determine the choice of homeopathic remedy. For example, a patient with a psoric background would require a psoric remedy and the prognosis of recovery and response to treatment would be quicker and more hopeful. Whereas a person with a syphilitic miasmatic background, the choice of remedy should be deep acting and anti-syphilitic – a superficial remedy would only palliate. There is a high possibility of complications and ups and downs during recovery unless a good antimiasmatic constitutional remedy is prescribed sooner rather than later to support the treatment.
- Ultimately, recovery needs to be supported by appropriate lifestyle changes made by the patient for the long term. This advice needs to be give on the basis of miasmatic background of the individual, taking into account past and family history.
Having said all this, the best patients to treat, are those who come for homeopathic treatment at the early stage of cardiac pathology. Maintaining these patients on good long term constitutional medication helps prevent further development of complications, prevents them from getting into an emergency situation, and helps them recover more quickly. These are patients who can be treated at home, if THEY so choose. This is an option most people above the age of 80 years prefer. But it’s always safer to have them under observation, especially younger age groups and those admitted to a hospital for the same. The difficulty here is that the allopathic protocol will be an interference and a hindrance if the attending cardiologist is not supportive of homeopathic treatment.
IV What is a realistic expectation of Homeopathic treatment in Cardiac Patients?
Homeopathic treatment is able to reverse pathological changes over time. For this to happen, obviously the remedies prescribed should be based on the pathological changes of that particular cardiac event. Two of our masters who treated patient in this way and hence obtained great success in serious diseases were John Henry Clarke and Cyrus Boger. Both of them have given beautiful perspectives in their material medica of the pathological scope of the remedy, obtained either through clinical experience or through study of the poisoning effects of remedies. Read through their materia medica of cardiac remedies if you really want to know how to prescribe them in pathological conditions. There are valuable insights.
For example, a cardiac picture indicating Cactus as a remedy will present with any permutation or combination of the location, sensation, modalities, concomitant (LSMC) given above. We need to observe carefully and note these down – in a couple of minutes. Boger’s Repertory itself will lead one to this prescription, or else Clarke’s “The Prescriber”. Knowing the materia medica well, is half the work as far as remedy choice is concerned. We must learn to differentiate the modalities between remedies first, to know their different applications. In addition we have software today to help us get a remedy within a few minutes. The homeopath needs to have a command of his senses, observe carefully, know his remedy characteristics and have a keen clinical judgment. All this working together would make us competent homeopathic cardiologists.
Let me elaborate how Clarke and Boger have given us a clinical perspective of the presenting picture of a cardiac patient with an example from the Materia Medica:
CACTUS GRANDIFLORUS – indicated for ACS, Angina
- Cyrus Boger
HEART (muscle). (SCOPE general)
Circular Muscles. (SCOPE specific is cardiac muscle contraction, blood
WORSE lying on left side. (MODALITIES)
WORSE lying on left side.
WORSE periodically. exertion 10 -11 A.M, or 11 P.M.
BETTER open air.
BETTER pressure on vertex.
CONSTRICTIONS, heart, chest, neck, body feels tight or wrapped, (Baryta carb.
Grap. Medorrhinum Nux-v. Sul.). (SENSATION of pain is constriction)
Irregular circulation. (Scope is muscular tissue of blood vessels)
Hot gushes into chest.
Localized pulsations, behind stomach.
Pains that extort cries.
Periodical neuralgias. (scope is peripheral nerves)
As of a weight on vertex or chest. (sensation is of weight)
Red face. (Concomittant)
Cough, from heart affections, rattling. (Pathological symptom)
Menses lumpy, black, cease on lying.
HEART FEELS CLUTCHES AND RELEASED ALTERNATELY, BY AN
IRON HAND, or feels it expand and contract, seems to turn over (lach.),
stitches, irritable, intermittent beat.
As if an iron band about chest.(Further differentiation of feeling of
Numb left arm. (Concomittant)
Fingers tingle. (Concomittant)
Chill, not amelioration covering. (Concomittant)
Strong pulsations in odd places. (Concomittant)
Related: Aco. Coc-c.
Now let us see how Clarke gives his perspective:
- John Henry Clarke
We are indebted to Rubini of Naples and his devoted wife for the first provings of this great remedy. Cactus affects powerfully the entire organism, but its intensest operation is on the heart and circulation. (Scope)
In congestive violence it rivals Aconite, which is one of its antidotes.
As with Aconite, too, the pains are unendurable, they extort screams. (Remedy relationship/differentiation in cardiac conditions)
Sadness, apprehension, fear of death and a tendency to be easily frightened characterize the Cactus mental state, as they do many conditions of heart disease. (Mental State – concomitant)
Given as an organ-remedy it will benefit a large number of cases of weakened and painful heart, and if its keynote symptom of constriction—”as if an iron band prevented its normal movements,” or “heart as if compressed violently and as violently struggled to burst its bonds”—is present, it will cure. (Sensation)
Pain and numbness in left arm accompanying heart disease. (concomitant)
Sharp pains in diaphragm and girdle pain round its attachment. (concomitant)
Indigestion with these symptoms. (concomitant)
Snader considers Cactus specially indicated where the heart is weak and the arteries atheromatous. (Pathological scope)
This is confirmed by a venerable correspondent of the Hom. World (July, 1898), who, finding his temporal arteries much swollen and hard to touch, took several doses of Cact. Ix, with the result that in a few days they became normal. (Clincial experience of pathological scope)
Snader uses the lower attenuations in this condition. (Posology)
A case of angina pectoris was cured by the 30th, with the following characteristic: sensation as though a swarm of hornets were going from pectoral region to heart.(Clincial experience of sensation)
Cactus has the weakness and coldness of the extremities which characterize many heart cases, and render it an appropriate remedy. (concomitant)
Constricting pains run through the pathogenesis (throat, chest, heart, bladder, rectum, vagina). (Sensation)
Twitching of muscles, and sensation of constriction produced by touching the affected part. (Causation/Sensation)
Hemorrhages (nose, lungs, rectum, stomach).
Sanguineous congestions, which are in a way a counterpart of the constrictive sensations.
Among the other prominent symptoms of Cactus are: “Heavy pain in vertex, like a weight.” “Periodical attacks of suffocation, with fainting, cold sweat on face, and loss of pulse.” “Fluttering and palpitation of heart, worse when walking or lying on left side.” “Heart disease with swelling of left hand only.” “Numbness of left arm.” “Rheumatism of all joints, beginning in upper extremities.” The pains are very sharp, causing the patient to cry out. (Proving symptoms that may be clinically significant in cardiac cases)
Many symptoms are worse at night (“Night-blooming Cereus”).(Modalities)
Menses cease at night.
Many symptoms worse lying down, or come on when lying down.
Periodicity is well marked (quotidian fever, 11 a-m.).
Chill at same hour every day, 11 aor 11 p-m.
V Post Acute Stage Management:
Treatment of acute pathology and disease presentations is never complete without the backing of an antimiasmatic constitutional remedy. In fact, once the disease presentation becomes chronic, the constitutional remedy becomes the main curative agent and also the maintainer of homeostasis – to the point that it prevents progress of the disease and prevents repeated episodes of the same condition. It also prevents complications by its ability to maintain homeostasis and avoid effects of “stress” – both mental and physical.
From the Cardiac perspective – the prevention required is to prevent clot formation, reduce chronic inflammation, prevent platelet aggregation, reduce LV remodeling. The latter is a phenomenon of cardiomyopathy that results in cardiac failure following both IHD and Myocarditis. Over time, a homeopathic remedy can reduce target organ damage caused by hypertension as well as improve valvular function in rheumatic heart disease. More often than not, these conditions require the support of specific remedies or phase remedies indicated by the specific disease presentation or just by the pathology. These remedies are also specific remedies in our material medica or Organ remedies prescribed as mother tinctures or in very low potency.
We can see below how our masters treated cardiac conditions with homeopathic remedies with great confidence mainly because they were clinically sound in their diagnosis.
EG: CRATAEGUS OXYNANTHA
- John Henry Clarke
Crataegus was introduced into medicine as a heart remedy by Dr. Greene, of Ennis, Ireland, and it has been used empirically with much success in cases of heart failure.
It has usually been given in 5-drop doses of the tincture.
Weak and rapid pulse, dyspnea and dropsy, dependent on failure of heart-power whether from valvular affection or from anemia, appear to be the leading indications.
Heart-failure threatened from slightest exertion.
The drug may cause nausea when given in the tincture unless given during or immediately after a meal.
The mental state is that of irritability, crossness, and melancholy.
Crat. is the nearest approach to a positive heart tonic that I know of.
It has produced some heart symptoms and has, doubtless, a homeopathic relation, but it is not a heart-poison like Digitalis, and has no cumulative action
Here are some cases: Halbert in Clinique, March, 1899, records this case: “Mr.
S., a young man sixteen years of age, had worked hard at manual labor since his twelfth year to support a widowed mother. He had, in fact, done a man’s work before his physical maturity would permit it. For some time he has shown some signs of cardiac hypertrophy, and had been cautioned by physicians to take good care as to his heart. About a year ago, during some gymnastic extreme in the nature of sport, he was suddenly admonished that something had ‘given way,’ and for relief was obliged to take to his bed.
When I first saw him he was obliged to lie down, respiration was labored and irregular, and the heart’s action was greatly exaggerated and erratic.There was decided precordial bulging, the apex beat was considerably displaced, downward and to the left, and the whole cardiac dullness was greatly extended, the impulse was heaving in character, with considerable mitral systolic blowing and the corresponding diastolic intensification, there were also signs of considerable pulmonary engorgement and some pain in the chest region.
The patient was put into a warm bath for twenty minutes, and then carefully returned to bed. Aconite 3X was administered every half-hour, and continued hourly for a day or two afterward until he was somewhat relieved. Crataegus, five-drop doses of the tincture, was than administered five times daily for a long time. The effects of this remedy were most remarkable, the cardiac irritation gradually lessened, the area of dullness decreased and the rhythm improved, at the same time all the general symptoms improved rapidly. He has now been using the remedy for several months, and the result is most satisfactory.
As a precaution, in patients with a family history of heart disease, begin treatment at a younger age to prevent future cardiac problems. In these patients it is important to pay attention to cardiac related symptoms as precursors of future cardiac disease. Hence it is so important to take into account the family history of every patient when evaluating symptoms for their cardiac related significance.
Finally lifestyle change, – Diet, exercise, Adequate sleep/rest, Weight loss in Obese patients, are important components to supportive treatment in Cardiac patients.
VI ANATOMY and PATHOPHYSIOLOGY:
Let’s take a quick look at few important perspectives every homeopath needs to have of cardiology related anatomy and pathophysiology.
- Coronary Vessels:
To properly evaluate and examine cardiac patients, we need to first know the anatomy and pathophysiology of the heart and its musculature, valves and blood supply. The arteries that are bypassed in grafting or opened with stents, are the external coronary arteries (the right and left coronary arteries and their branches) – seen in the figure below.
Coronary Angiograms examine the coronary arteries for poor blood supply and decisions on stents to be inserted in blood vessels or cardiac bypass surgery are made by evaluating this investigation along with others. In cases with less than 70% blockage of coronary vessels, stents can be avoided. Homeopathic treatment can play a vital role in maintaining good cardiac status, blood supply and dissolving blockages.
- Systemic and Pulmonary Circulation:
A clear understanding of the TWO circulations that the heart is involved with in every heartbeat – the Systemic circulation and the Pulmonary circulation, helps us evaluate the function of the heart musculature. The interaction between the heart and each of these two circulations plays a dominant role in the functioning of the heart:
Eg: Heart failure (left sided) in its various stages – is an interaction between the heart and the systemic circulation – of compensatory mechanisms and supportive effects. The homeopathic remedy choice becomes more accurate if one understands the pattern of symptom presentation and the pathology involved:
Is the problem with cardiac muscle weakness? (Strophanthus, Adonis, Crataegus, Convallaria, Iberis, ) Is the problem with electrolyte imbalance (Na, K, CL, Ca)? (Nat Mur, Kali Carb, Apocynum)
Is the problem with renal perfusion? (Digitalis, Sarothamnus Scoparius)
Is the problem with systemic circulatory blood vessels? (Lycopus, Lachesis, Phos)
Is the issue related to blood pressure or diabetes complications? (Phaseolus, Aconite, Viscum Alb)
Is the problem valvular in origin? (Kalmia, Naja, Lauroceracus)
In each of these instances, the choice of remedies may differ depending on their prominent scope of action. That is why it’s important to understand the scope of indicated remedies – do they have a functional or hormonal action? Do they have an action on muscular fiber or renal perfusion and filtration or electrolytes, etc.
Cardiac Asthma is a cardiac induced asthmatic condition of the lungs – heart failure here (right sided) that involves the pulmonary circulation and its compensatory mechanisms. Here the focus would be to choose remedies that have an action on pulmonary circulation and lung parenchyma in addition to cardiac scope. (Grindelia, Antim Ars, Ars Alb, Digitalis, Aspidosperma Quebracho)
- Coronary Artery Disease: Is the manifestation of coronary arteries hardened by atherosclerosis and narrowed, resulting in reduced oxygen supply to the heart muscle. Depending on which artery is affected, symptoms and ischemia arise in supplied areas of the heart muscle.
It involves the two main arteries supplying the heart that arise right out of the base of the Aorta. The Left Coronary Artery (LCA) divides into the left anterior descending artery (LAD) and the circumflex branch, supplying blood then to the heart ventricles and left atrium.
The Right coronary artery (RCA) divides into the right posterior descending artery and a large marginal branch. It supplies blood to the heart ventricles, right atrium and sino-atrial node.
Additional arteries that branch off the two main coronary arteries are:
The Circumflex artery (Cx) branches off the left coronary artery and encircles the heart muscle, supplying blood to the back of the heart.
Left Anterior Descending (LAD) branches off the left coronary artery and supplies blood to the front of the heart.
These are the main arteries that are investigated from atherosclerotic plaques causing narrowing and precipitating coronary artery disease.
Atherosclerosis is process of plaque formation and rupture that has been observed in arteries.
The various stages include:
– Inflammation of arterial wall
– Leukocyte recruitment with accumulation of lipoproteins
– Cytokines and growth factors
– Fibrous tissue deposition with necrotic core
– smooth muscle cell synthesis à fibro-fatty lesion
– athero-thrombus: abundant plexuses of micro-vessels with vasovasorum
– foci for intra plaque rupture and hemorrhage
– Thrombosis and calcification of the ruptured area of the blood vessel
- Angina Pectoris :
– imbalance between myocardial blood supply and oxygen demand.
– usually exertional or from emotional stress
– includes s/s choking, chest discomfort, jaw/neck pain
Remedies: Amyl Nitricum, Cactus, Adonis,
Coronary Artery Vasospasm :
– Coronary atherosclerosis
– Location of obstruction of coronary arteries
– Duration of spasm : transient, reversible (ischemia if <20 mins.), permanent (necrosis if >20 mins.)
- Acute Coronary Syndrome:
This refers to a spectrum of clinical presentations, including the previously mentioned atherosclerosis, angina pectoris and coronary artery vasospasm.
The presentations clinically range from those of ST Segment Elevation Myocardial Infarction (STEMI) to those found in Non- ST- Segment Elevation Myocardial Infarction (N-STEMI) or in unstable angina. It is almost always associated with rupture of an atherosclerotic plaque or and partial or complete thrombosis of the infarct related territory.
The Signs and Symptoms associated with primary ACS include:
- Pain, which is usually described as a pressure squeezing or burning sensation across the precordium and may radiate to the neck, jaw, shoulder, back, abdomen or either arm
- Exertional dyspnoea or pain that resolves with rest
- Diaphoresis from sympathetic discharge
- Nausea from vagal stimulation
- Decreased exercise tolerance
Homeopathic Cardiology can be a reality and a true hope for the future in cardiac patients. It can be a reality because there are a host of clinical conditions that modern medicine still has no answers for. These include Cardiac Failure and Cardiomyopathy where homeopathic remedies provide tremendous scope. Homeopathic treatment provides recovery from within, an area that modern medicine has no control over. Homeopathic treatment provides treatment for stress induced conditions and hence works as a preventive of cardiac emergencies. Homeopathic treatment is non invasive, inexpensive and worth the investment for long term management, especially if the patient is on good constitutional treatment. The case in this issue of the journal: Cardiac Failure with Cardiomyopathy in a patient with Chronic Lymphocytic Leukaemia will illustrate this perspective.View that case here:
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