KEYWORDS : Heart Failure, Digitalis, Strophanthus Hisp, Adonis Vernalis, Phaseolus Nana, Research, Homeopathy in cardiology
INTRODUCTION : Congestive Heart failure (HF) is the inability of the heart to empty itself adequately during systole, resulting in a high venous filling pressure and a decrease in the effective work done by the myocardium. HF can no longer be considered a simple contractile disorder of the heart alone.
Clinical features are the result of intrinsic changes in the cellular and molecular components and to the mediators that cruise the homeostasis. There is a general acceptance that as heart disease progresses into the stage of failure, the heart size increases, the cardiac function deteriorates and symptoms become evident.
Cardiomyopathy is a terminal life-long myocardial failure disease wherein it is unable to pump an adequate supply of blood into the circulation. Certain types are: Hypertrophic (HOCM); Dilated (DCM); Arrythmogenic Right ventricular (ARVC), restrictive (RCM), peripartum (PPCM), Takotsubo stress induced, etc
Cardiac remodeling is the attempt of the vital force to restore balance. It encompasses the varied genomic expressions as changes in size, shape and function of the heart associated with progressive failure and is accepted as a determinant of the clinical course of HF – the patho-physiologic changes that occur after a myocardial infarction, pressure overload (aortic stenosis, hypertension), myocarditis, DCM or volume overload (valvular regurgitation).
Physiologic remodeling are the compensatory changes in the proportion and function of the heart as seen in athletes. Although patients with major remodeling have progressive worsening of cardiac function, slowing or reversing remodeling has only recently become a goal of HF therapy.
The global standards to quantify and assess HF are Echocardiographic data of Left Ventricular Ejection Fraction (LVEF), New York Heart Association (NYHA) Class and Levels of N Terminal pro B Type Atrial Natriuretic Peptides (NT-pro-BNnP). HF can be sub classified on LVEF values as
- HF with low LVEF
- HF with mid range EF
- HF with preserved ejection fraction.
Clinically one can adopt a 6-minute walk test to assess HF. Echocardiographic data of LVEF and end-systolic volume provide support for the beneficial effects of therapeutic agents such as Digitalis, Strophanthus Hispidicuns (S), Adonis Ver (A) and Phaseolus Nana (P) on the remodeling process. These agents also provide benefits in terms of morbidity and mortality.
Digitalis – It is a well proved homoeopathic remedy and a historical drug for HF, where the pulse is weak (low volume), irregular, abnormally slow (supine posture) and there is external and internal dropsy. Myocarditis, atrial fibrillation/ flutter, complete heart block are other prominent indications.
The symptoms are sinking of strength, faintness, coldness of skin, deep sighing respiration, dry cough < walking, talking and bending, chest soreness, jaundice, cyanosis, and collapse. In addition palpitation aggravated on least motion and sensation as if the heart would cease beating, if he moves (Opposite Gels).
Strophanthus hisp – It is a partially proved remedy in homoeopathy. In crude form, it increases the contractile power of all striped muscles. Acting on the heart it increases the systolic power (Ejection fraction) and decreases the heart rate. It also diminishes dropsies or effusions (Digit) and thereby aids in treating pneumonitis and pulmonary edema.
Ailments from long use of nasal decongestants, steroids, alcohol, caffeine, nicotine – tobacco, marijuana, heroin, LSD, cocaine, and amphetamines etc described as “irritable heart of tobacco-smokers” (smoking-induced cardiac arrhythmia due to carbon monoxide, oxidative stress and pro-fibrotic effect of nicotine on myocardial tissue and an increased susceptibility to catecholamine). Arterio-sclerotic peripheral arteries of the aged.
Strophanthus alleviates the symptoms of diseases such as bronchial / cardiac asthma, exophthalmic goitre or anemia presenting with palpitation, precordial anguish, dyspnoea aggravated on ascending and albuminuria. In hypertensive temporal headache where patients have diplopia, flushed face, nausea, disgust for alcohol and an unusual fear of ordeals, Strophanthus relieves.
Adonis vernalis – It is a partially proved remedy in homoeopathy. In crude form it is indicated in cardio-myopathy or chronic heart failure due to Mitral or aortic regurgitation, pericarditis, infectious myocarditis (Quebracho), Rheumatic Endocarditis (Kalmia), chronic Aortitis, fatty heart (atherosclerosis), etc.
The presenting features are anasarca (hydrothorax, ascites), precordial constriction, palpitation, dyspnoea, vertigo, apprehension, anxiety, and restlessness (Ghabrahat) and albuminuria. The pulse is rapid, low volume, irregular (Digitalis). ECG: tachyarrhythmia and extrasystoles which are so often associated with many patients suffering from a heart condition (Leonunus, Lycopus)
Phaseolus nana – It is an unproved remedy in homoeopathy. In its crude form it is indicated clinically in cardiac dysfunction when the ejection fraction falls below 35%. The presenting features are slow and sighing respiration, tachycardia, palpitation, a sick feeling in the precordium (Ghabrahat), and right ribs sore. The patient may have pleural or pericardial effusion. There is a sensation as if death is approaching. In males there may be erectile dysfunction.
Objective: To Study the comparison between Digitalis and three other partially proved homoeopathic remedies – Strophanthus hisp, Adonis vernalis and Phaseolus nana in improving the quality of life of patients of chronic Heart Failure
Methods: We prospectively included 300 patients of Chronic HF presenting to the OPD’s of The National Academy of Homoeopathy, India from from 3/4/2008 to 3/4/2018. History of chronic congestive heart failure (CHF) determined from medical records, physical examination and investigations.
Cases were selected from all 3 varieties (HF with low, mid or normal ejection fraction). The cases were typified as- I (Natural case – clear generals); II (Incurable), III (One-sided disease); IV (Settled case + other co-morbid conditions). The cases were then repertorized and a symptomatic simillimum selected and administered in the required potency
If the well selected medicines did not work, then any of the four remedies namely Digitalis (D), Strophanthus (S), Adonis (A) or Phaseolus (P) were given in potencies starting from 3ch to 30ch on a daily basis since this was a pathological prescription based on pathological totality and not on uncommon peculiar individualistic symptoms.
We administered 3 pills / drops twice a day for at least few months depending upon each case.
Follow –up was done weekly, fortnightly or monthly, depending upon the case. The second prescription was based depending upon the action of the first prescription. Re-investigations (laboratory and / or radiological) were done as per the case.
Focus was given on Ejection Fraction obtained by 2D Echocardiography and 6 minute Walk Test in the clinic. We could not take Serum Natri-uretic Peptide levels as a follow-up tool as most of the patients in our private set up refused this investigation due to the cost involved.
Results: Among 300 patients with proved HF, the mean age was 64.5±11 years with Male predominance. The co-morbidities were Hypertension, Diabetes mellitus, hyperlipidemia, coronary artery disease, Chronic Atrial fibrillation, valvular heart disease and peripheral vascular disease.
The causes of HF – Chronic DM + CAD (37.66%); Post MI (33%); RHD (24%); HOCM (4.33%), Post Chemotherapy (1%). Course: Patients till the end of study (72.3%); Left (22%); Died (5.7%). Number of Patients Who Received Each Drug – D (39%); S (32.66%), A (15%) & P (13.3%).
Effects of Drugs on Improvement in 6-Minute walk Test – D (34.18%), S (80.61%), A (42.22%), P (20%)
Effects of Drugs in improving the Ejection Fraction by more than 5% D (41.9%), S (53%), A (24%), P (12.5%)
In the multivariate analysis, CHF (OR 1.18; 95%CI 1.01- 1.37) was an independent predictor of death and disability after adjusting age, severity, and other comorbid conditions.
Conclusions: In this prospective study, we could conclusively prove that the homeopathic potencies of Strophanthus Hisp > Digitalis > Adonis Ver > Phaseolus nana could effectively aid in improving the quality of life of patients of chronic Heart Failure both in terms of symptoms and the Ejection Fraction on ECHO.
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