Being a final year student I was recently introduced to the subject of medicine. While reading one of the most vital systems, i.e. the cardiovascular system, I realized how our materia medica treasures all these wonderful remedies which precisely cover heart conditions and their underlying pathology. All we need to do is study these drugs in depth in order to rise above the common symptoms and understand the characteristics! When I changed my perspective of learning these drugs, it really helped me to see them differently. I am writing this article hoping that you would benefit from it too.
Let me begin with discussing a case,
My teacher, during his early practice saw this patient, who had severe dyspnoea. When he entered the clinic, he could not walk a few steps from the hallway to the cabin. He almost took 10 minutes to cover those few steps and was completely breathless by the time he reached the cabin. His reports mentioned he was suffering from ischemic heart disease and his presenting condition suggested a myocardial infarct. Due to the severity of his symptoms he was referred to a cardiologist and was admitted in hospital. Later on when he was stable; he returned to the clinic and my teacher initiated the process of case taking by asking him about his complaint. He mentioned he was sensing pain in his chest (pointing his finger towards his chest in random spots). He also said the pains kept shifting from spot to spot over the chest. We got these two symptoms out of 4 pre-eminent symptoms that Clarke has mentioned in order to prescribe kali bichrom i.e.1. occurrence of pain in spots & 2. alternating, shifting pains which wander from part to part. And on basis of these symptoms Kali bichrom was given, however kali bichrom failed in this case. Later when we were studying Adonis Vernalis we realized Boger had mentioned in the first line of this drug that Adonis has wandering type pains along with heart affections. Due to its wandering type of pain it is usually given in heart conditions after rheumatic affections. Another symptom of Adonis is… it increases the power of contraction of the heart with increased urinary secretions indicating that the kidney is the end organ damage here.
Apocyanum is another remedy, where the heart’s action is depressed along with decreased urinary secretion where diuresis occurs in order to remove dropsical effusions. Many a times after heart surgery the patient’s urinary output decreases, Dr.Kent has suggested that Apocyanum can be given in such post operative complications of decreased urine output after heart surgery. And since it is one of the most common post-op complications seen after angioplasty in today’s age, remembering this symptom of this apocyanum will help you very much. Just as kidney is the end organ damage in some cases, in some cases the liver may present as end organ damage. And for those cases we have remedy digitalis to our rescue. Boericke in the first paragraph mentions jaundice with heart disease, indurations and hypertrophy of liver along with heart complaints. Digitalis is also thought of in patients suffering from weak irregular intermittent pulse which is abnormally slow.
The pulse is slow in recumbent position. The least movement causes violent palpitations and sensation as if the heart would cease beating if he moved.(opp is seen in gelsemium where it is necessary to keep in motion or else patient feels that the heart would cease beating, and a similar symptom is also seen in mag mur where palpitation and cardiac pain occur while sitting and are better while moving about).
In digitalis the patient feels like 3, 5, 7 beats are missing. When we consider heart rate we should always consider naja as one of the remedies. In naja the pulse is as slow as 45b/m. They are irregular as well and this is more due to paralytic affections that this drug has. Usually given in heart conditions after infectitious disease and in patients who are depressed out of guilt with suicidal tendency. Lilium tig has bursting pulsations all over the body. Allen has mentioned that the pulse is irregular and as rapid as 150-170 b/m. Kalmia latifolia again has slow weak pulse around 35-40b/m. Another important indication of kalmia is heart affections after rheumatic fever occurring due to streptococcal infection after throat complaint. The patient develops heart and joint affection. Boericke mentions gouty rheumatic metastasis of heart. And as rheumatic pains are rapid and sifting, so are the pains of this drug. Dr.Allen has described these pains as darting, pressing, shooting especially in a downward direction. Also rheumatic affections usually affect the valves and you won’t be surprised when you read how this drug covers valvular insufficiency. And once we come across a case of valvular insufficiency we should always remember to consider convallaria majalis along with kalmia. And I say so because of its main symptom, .i.e sensation as if heart ceased beating, and then starts suddenly which is generally observed in mitral valve prolapse. Even lycopus has flying pains of rheumatism associated with heart complaints. And here we see haemoptysis which is more due to valvular heart disease than respiratory disease. Boericke has mentioned that lycopus has forcible, tumultuous action of the heart with more or less pain. Palpitations occur from slightest nervous excitement.
Laurocerasus is one of the remedies for heart affections occurring along with respiratory complaints and its main symptom is cyanosis neonatorum. Clutches at heart and palpitations with gasping for breath. Up next is spongia which is indicated especially for the tubercular diathesis. The patient may also complain of disturbed sleep where he suddenly awakens after midnight with pain and suffocation and is frightened to death. Spongia patients have a typical sensation of surging of heart into the chest as if it would force upwards. Crategus oxycantha also has air hunger but it is mostly given for hypertension. It is also said to be a heart tonic. Pain in left clavicle is an important keynote of this drug.
Like Crategus is for hypertension we have cactus for angina. I say so because of the constricting pains that this drug has which are the typical pains of angina. These constricting pains are experienced as if the whole body is caged and each wire is being twisted tighter and tighter and the heart is clasped and unclasped rapidly by an iron band as if it had no room to breathe.
We also have a remedy for frequent palpitations, i.e. spigelia. It has violent palpitations which are aggravated by least exertion. As mentioned earlier lycopus has violent palpitations but these are more due to nervous excitement. The patient experiences stitching, thrusting, neuralgic pains in the chest, like that from sharp instruments. There is marked pin mania as well. It is a remedy for symptoms due to the presence of worms and the child usually refers to the navel as the most painful part.
We have considered all the organs that may be affected along with heart conditions, so we just cannot forget to consider the mind along with heart affections. Surprisingly, we have enough drugs for heart affections along with hysteria, i.e Iberis amara. It has nervous and vascular excitement which causes violent palpitations, even from the slightest exertion. Aphonia with heart attack is the most striking feature of this drug.
With this I would like to conclude this article hoping that next time when you come across a cardio-vascular case, it will get easier for you to understand the patho-physiology of these drugs and prescribe them more accurately.