Role of homoeopathy in management of myocardial infarction

Dr Viraj Alawa, Dr Mirnalini Chauhan
Under Faculty of Homoeopathic Sciences,
Jayoti Vidyapeeth Women’s University, Jaipur.

ABSTRACT
Cardiovascular diseases fall under major cause of morbidity and mortality and is considered a rapidly growing problem worldwide. It is estimated that over 40 million Indians have some kind of cardio vascular diseases.  The symptom manifest most often as chest pain or chest discomfort. The best way to reduce the incidences of cardiac diseases is by avoiding or minimizing the risk factors that triggers the disease.  The efforts to control life style diseases which are major risk factors for cardio vascular diseases will definitely contribute to the cardio vascular disease prevention.  Homeopathy offers a significant complementary role in the management of cardiovascular diseases, can be either preventive, curative or palliative. Materia medica has number of medicines that could be effective in managing the cases of MI. It is proved helpful in eliminating the risk factors, preventing the progress of disease, and preventing sudden death and morbidity due to myocardial ischemia.

INTRODUCTION

Cardiovascular diseases are the major cause of death globally. Myocardial infarction represents a serious clinical manifestation among Ischemic heart diseases and is associated with high mortality and morbidity. Chest pain is a common presentation in patients with MI. The assessment of possible MI includes evaluation of risk factors and presenting signs and symptoms, rapid ECG, and serum cardiac troponin measurements. ⁽¹⁾

Myocardial infarction (commonly referred to as heart attack) is the death of cardiac muscle due to prolonged severe ischemia. It falls within the category of “Ischemic Heart Diseases” resulting from myocardial ischemia – an imbalance between myocardial supply (perfusion) and cardiac demand for oxygenated blood. The clinical presentation of MI varies from a minor coronary event to life-threatening clinical situations or sudden death. ⁽²⁾

Myocardial infarction can be further studied into three types:

• ST-segment elevation myocardial infarction (STEMI): This is caused by a complete obstruction in the blood supply i.e. total blockage of the coronary artery which results in extensive damage to the heart.
• Non-ST segment elevation myocardial infarction (NSTEMI): It is less serious than STEMI as there is a partial obstruction in the blood supply and the damage to the heart is less as compared to STEMI.
• Unstable angina: In unstable angina, the blood supply to the heart is partially affected, but there is no permanent damage to the heart, so the heart muscle is preserved. ⁽³⁾

The usual cause of sudden blockage in a coronary artery is the formation of a blood clot (thrombus). The blood clot typically forms inside a coronary artery that already has been narrowed by atherosclerosis, a condition in which fatty deposits (plaques) build up along the inside walls of blood vessels. ⁽⁴⁾

Each coronary artery supplies blood to a specific part of the heart’s muscular wall, so a blocked artery causes pain and malfunction in the area it supplies. Depending on the location and amount of heart muscle involved, this malfunction can seriously interfere with the heart’s ability to pump blood. Also, some of the coronary arteries supply areas of the heart that regulate heartbeat, so a blockage sometimes causes potentially fatal abnormal heartbeats, called cardiac arrhythmias. ⁽⁴⁾

Although most heart attacks are caused by atherosclerosis, there are rarer cases in which heart attacks result from other medical conditions. These include congenital abnormalities of the coronary arteries, hypercoagulability (an abnormally increased tendency to form blood clots), a collagen vascular disease, such as rheumatoid arthritis or systemic lupus erythematosus (SLE, or lupus), cocaine abuse, a spasm of the coronary artery, or an embolus, which floats into a coronary artery and lodges there, resulting in obstruction of the artery.  The diagnosis is done by ECG and biomarkers. The first line of treatment is usually the administration of Aspirin and other medicines to prevent blood clotting in the coronary arteries. The patient also will be given oxygen, pain medication, and beta-blockers. ⁽⁴⁾

Incidences:

• MI can occur at any age; nearly 10% of a myocardial infarction occurs in people less than 45 years of age and 45% occur in people younger than 65 years of age.
• The frequency rises progressively with increasing age.
• The male is relatively at higher risk than females. MI has a strong genetic correlation also.
• However, the incidence is decreased in the industrialized nations partly because of improved health systems and the implementation of effective public health strategies. ⁽²⁾   

Risk factors:

• Obesity and physical inactivity.
• Hypertension.
• Smoking.
• Alcoholism.
• Family history of a heart attack.
• Previous history of a heart attack.
• Diabetes Mellitus.
• Abnormal lipid levels. ⁽²⁾

Pathogenesis:

The main cause of the myocardial infarction is the Coronary artery occlusion.

• A coronary artery atheromatous plaque undergoes an acute change consisting of intraplaque hemorrhage, erosion or ulceration, or rupture, or fissuring.

When exposed to subendothelial collagen and necrotic plaque contents, platelets adhere, become activated, and release their granule contents and aggregate to form microthrombi. Vasospasm is stimulated by mediators released from platelets. Thus, activating tissue factors and collagen pathway, adding to the bulk of the thrombus. Within minutes, the thrombus can expand to completely occlude the vessel lumen. ⁽²⁾

In approximately 10% of cases, the cause of MI can be:

• Vasospasm with or without coronary atherosclerosis.
• Emboli from left atrium in association with atrial fibrillation or paradoxical emboli from the right side of the heart.
• Ischemia without detectable or significant coronary atherosclerosis may be caused by disorders of small intramural coronary vessels, hematologic abnormalities (E.g. Sickle cell anemia), amyloid deposition in the vessel wall, lowered systemic blood pressure, etc. ⁽²⁾

Clinical features:

• Chest pain:  Pain or discomfort in the center of the chest. Pain extending to left shoulder, arm, jaw, neck, or back. The pain is intense and lasts for more than 20 minutes.
• Heaviness, tightness, pressure, aching, burning, numbness, or fullness sensation in the chest.
• Nausea or vomiting.
• Difficulty in breathing or shortness of breath.
• Cold sweating.
• Lightheadedness, weakness, fainting, anxiety.
• Irregular heartbeats. ⁽⁵⁾

The patient’s vital signs may demonstrate the following in MI:

• The patient’s heart rate is often increased (tachycardia).
• The pulse may be irregular.
• In general, the patient’s blood pressure is initially elevated because of peripheral arterial vasoconstriction resulting from an adrenergic response to pain and ventricular dysfunction
• However, with right ventricular MI or severe left ventricular dysfunction, hypotension and cardiogenic shock can be seen
• The respiratory rate may be increased in response to pulmonary congestion or anxiety
• Coughing, wheezing, and the production of frothy sputum may occur. ⁽⁶⁾

Diagnosis:

• History: Ask the patient about the onset of the pain and the extension. Whether he is experiencing it for the first time or he had any previous episodes. Ask if he has any history of diabetes, hypertension, smoking, alcoholism.
• ECG: The classic ECG changes are:

             T wave inversion

             ST-segment elevation

             Abnormal Q wave.

• Cardiac markers: Raised CKMB and troponins.
• Angiography: to detect the percentage of damage. ⁽⁷⁾

General management:

When a patient with suspected cardiac arrest is encountered, the ABCDE approach to management should be followed: this involves prompt assessment and restoration of the Airway, maintenance of ventilation using rescue Breathing, and maintenance of Circulation using chest compressions; Disability, in resuscitated patients, refers to an assessment of neurological status and Exposure entails the removal of clothes to enable defibrillation and auscultation of the chest. ⁽⁸⁾

Lifestyle management is the most effective way to prevent heart attack or having another heart attack.

These are the main steps you can take to help prevent a heart attack (as well as stroke):

• eat a healthy, balanced diet.
• do not smoke.
• try to keep your blood pressure at a healthy level.
• Exercise regularly.
• Limit your alcohol intake
• Monitor your cholesterol levels.
• Control your sugar levels. ⁽³⁾

Homeopathic management:

Homeopathic medicines are beneficial acting on the heart muscles, coronary circulation, strengthening the walls of blood vessels, improving the permeability and elasticity of vascular wall, normalizing their tone, relieves pain, normalizes heart rhythm, reduce fatigue and increases efficiency. ⁽⁹⁾

Amyl nitrate: Tumultuous action of the heart, with much dyspnea, felt through carotids up to the ears; heat, throbbing and intense fulness in the head; face deeply flushed; irregular, rumbling sort of sound in the heart, aggravation by motions and emotions; cannot endure warmth, open doors, and windows, even in cold weather; pulse slightly quickened. ⁽¹⁰⁾

Digitalis: Abnormal action of the heart; the sense of oppression, with the tendency of fainting; feeble or spasmodic pulse; oppression of the chest; pain extending to head and left arm; mental anguish with vertigo and fainting; heart’s action more vigorous than the pulse. In advanced cases, when the diseases set in suddenly, drawing, tensive, spasmodic pain in left chest and sternum, towards the nape of the neck and upper arm. Skin pale and cold. ⁽¹⁰⁾

Cactus-g: Nervous excitability; palpitation of heart in debilitated persons; feeling as though an iron band as around heart, preventing its motion, aggravation when lying on the left side, when walking and at night, with great melancholy; suffocative constriction at the throat, with full throbbing carotids; uncomfortable sensation at the pit of the stomach, as if feeling; periodical fits of suffocation, with fainting, cold sweat on face and pulselessness. ⁽¹⁰⁾

Glonoine: Great anguish in the precordial region; sharp stitches in the heart, with pricking pains in arms and hands; labored action of heart, with oppression and frequent pulse, he feels the palpitations all over, even to the tip of fingers; sensation of weakness and trembling. Aggravation on stopping and lying on the left side. ⁽¹⁰⁾

Lactuca virosa: Crampy stitching in the left chest, extending to the left scapula, and indescribable tightness of the whole chest; great oppression of chest at night, waking him from sleep and obliging him to sit up with anxious suddenness; feels as if he would suffocate. Pulse slow, contracted, and small. ⁽¹⁰⁾

Naja-t: Sudden attack of fluttering at the heart, with rising in the throat, and headache; sudden agonizing pain in heart; the unusual beating of heart, audible to the patient; heat and uneasy aching, with oppression in the heart; stitching pains in the heart; inability to speak with choking; pain not affected by inspiration; nervous chronic palpitation. ⁽¹⁰⁾

Spigelia: Abnormal action of heart, with pain aggravating when stretching himself out, when bending forward, lifting arm or from least motion; severe stabbing stitches in the heart at every beat; pain rapidly passing around the body from left to right; sudden severe pain in chest so violent that it knocks her down; weak, irregular pulse; strong but slow pulse; spasmodic pain in stomach inducing vomiting of contents of stomach and mucus but no bile. ⁽¹⁰⁾

Kalmia latifolia: Kalmia is a remedy for cardiac hypertrophy, especially after rheumatism, and has symptom so common in heart affections, namely. numbness of the left arm. There is with Kalmia much pain and anguish about the heart. The heart is irregular and intermits every third or fourth beat. There are shooting pains through the chest to the scapula. ⁽¹¹⁾

Lachesis: Lachesis produces palpitation of the heart and the constrictive feeling in the cardiac region. There is smothering sensation about the heart, waking the patient out of sleep. He can bear no pressure on chest. Pulse small and weak. ⁽¹¹⁾

DISCUSSION:

Case:1 – By Dr. Kent

A 31-year-old female presented with the complaints of headache begins in forehead and extends to occiput for last three months. Heart pains; stops beating then the sharp pain appears. Pain < hurrying. Aches and tumbles, from exertion and ascending stairs. Nausea and vomiting if eats one mouthful too much. There was soreness of vagina < after coition. Menses delayed, flow scanty, very dark or watery and offensive.  Clothes band around the waist causes pain. Pain <rising in the morning and forenoon. Desires warm room and warm clothing, desires sweets. Can sleep anytime during the day or night. He patient was prescribed Naja 10M Sac. 1 powder each night. After 20 days, the patient was feeling better in general, there was no heart pains, but there was sensation as if heart ceased beating. The patient was again prescribed Naja 10M. On follow up after a month there as marked improvement in over all condition the patient was again prescribed Naja 10M and after a month the soreness of vagina entirely disappeared, the patient also gained weight (107 lbs. to 129 lbs.) during the course of treatment. ⁽¹²⁾

Case :2 – Dr. Boenninghausen

A 38-year-old farmer presented with the complaints of stiches in the left side of chest since three to four months which aggravated when the patient moves about, work hard or gets excited. Palpitation of heart particularly on washing. Cough with putrid, yellowish expectoration, especially in the morning. Cold makes him feel worse. Itching in the shoulder blades and on chest. Past history revealed that about 18 months ago patient got wet though in the fields and there the problem started. Patient was prescribed Rhus toxicodendron (i. e., of each remedy to globules, moistened with the 200th dynamization of the centesimal scale). One dose every fifth morning.

After 20 days there was amelioration of all the complaints, but without complete removal of any.   Calc Carb 2m was prescribed along with Sac lac, one dose every fifth morning. Patient was feeling better overall and after 20 days again Sac lac was given, one dose every fifth morning. No further improvement was seen, patient had anxiety and oppression when lying down after meals. Patient was then prescribed Lycopodium 2m, and sac lac, one dose very fifth morning. There was marked improvement after 20 days and sac lac was given again which resulted in full recovery of the patient. ⁽¹³⁾

Homeopathic prescription is based on ‘individualization’. Considering the idea of vital force, the existence of the individualistic symptoms presupposes a certain amount of energy present to be applied for the process of cure in the person. The above cases have suggested that homeopathy is effective in the cases of cardiac diseases, if prescribed on the basis of symptom similarity.

CONCLUSION
Myocardial infarction is the common presentation of IHD and is one of the leading causes of death in India as well as worldwide. We aim to preserve the general wellbeing of the patient and to prevent complications. Homeopathy works on the principle of “Similars” and it aims to treat patients as a whole. So, homeopathic medicines along with lifestyle management have proven effective in reducing the incidences of MI and improving the quality of life of the individual. ⁽¹⁴⁾

REFERENCES

1. Craig Barstow, Md, And Matthew Rice, Md Jonathan D. McDivitt, Acute Coronary Syndrome: [Internet] Diagnostic Evaluation. American Family Physician 2017[cited 2017] Available from: https://www.aafp.org/afp/2017/0201/p170.html#abstract.
2. Kumar Vinay, Abbas Abul, Aster J C. Robbins and Cotran Pathologic Basis of Disease, South Asia Edition ed.: Reed Elsevier India Private Limited; 2015.
3. Heart attack [Internet];2019[cited 2019November 28]. Available from: https://www.nhs.uk/conditions/heart-attack/prevention/.
4. Heart attack. [Internet];2019[cited 2019 February]. Available from: https://www.health.harvard.edu/a_to_z/heart-attack-myocardial-infarction-a-to-z .
5. Myocardial infarction [Internet];2019[cited 2019 July 18]. Available from: https://my.clevelandclinic.org/health/diseases/16818-heart-attack-myocardial-infarction.
6. A Maziar Zafari. Myocardial Infarction.[Internet];2019[cited 2019 May 07] Available from: https://emedicine.medscape.com/article/155919-overview.
7. Robert Hutchison. Hutchinson’s Clinical Methods, 24 ed.: Elsevier Health Sciences; 2012.
8. Stanley Davidson. Davidson’s Principles and Practice of Medicine, 23 ed.: Elsevier Health Sciences; 2018.
9. Titieva N., 2001. https://patents.google.com/patent/RU2162332C1/en.RU2162332C1.
10. Samuel Lilienthal. Homoeopathic Therapeutics.:B. Jain; 1985.
11. Dewey, W.A. Practical homoeopathic therapeutics. (3rd ed.). : B Jain; 1901.
12. Kent, James Tyler. Clinical Cases by Pr J.T. Kent – Presented by Dr R. Seror. [Internet]; [cited 2016] Available from:  http://www.homeoint.org/books3/kentclin/index.htm#Naja
13. Team Homoeopathy360 [Internet]; 2017 [cited 2017 Jan 20] Available from: https://www.homeopathy360.com/2017/01/20/a-compilation-of-cases-of-rheumatism-by-our-stalwarts/
14. Das Beena. Myocardial Infarction. [Internet];2012[cited 2012 May 01] Available from:https://www.homeobook.com/ischemic-heart-disease-and-homoeopathy/.