{"id":8288,"date":"2012-05-01T05:15:50","date_gmt":"2012-05-01T05:15:50","guid":{"rendered":"http:\/\/www.homeobook.com\/?p=8288"},"modified":"2022-01-06T01:06:34","modified_gmt":"2022-01-06T01:06:34","slug":"ischemic-heart-disease-and-homoeopathy","status":"publish","type":"post","link":"https:\/\/www.homeobook.com\/ischemic-heart-disease-and-homoeopathy\/","title":{"rendered":"Ischemic Heart Disease and Homoeopathy"},"content":{"rendered":"

Dr Beenadas<\/strong><\/p>\n

Ischemic heart disease (IHD) is a condition in which there is an inadequate supply of blood and oxygen to a portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen supply and demand.<\/p>\n

Epidemiology
\n<\/strong>Myocardial infarction is a common presentation of IHD.\u00a0 In India, cardiovascular disease (CVD) is the leading cause of death. CVD\u00a0 affects Indians at a younger age, in their 30s and 40s. IHD is likely to become the most common cause of death worldwide by 2020.<\/p>\n

Risk factors
\n<\/strong>Risk factors for\u00a0 atherosclerosis are generally risk factors for myocardial infarction. They are diabetes mellitus, hyperlipidemia, hypertension, cigarette smoking, family history of premature IHD,\u00a0 advanced age, male gender, the postmenopausal state, obesity,\u00a0 high stress, OCP, inflammation- Elevated CRP blood levels, can predict the risk of MI, stroke and development of diabetes.<\/p>\n

Many of these risk factors are modifiable. Non-modifiable risk factors include age, sex, and family history – genetic predisposition.<\/p>\n

Pathophysiology
\n<\/strong>Under normal conditions, for any given level of a demand for oxygen, the myocardium will be supplied with oxygen-rich blood to prevent underperfusion of myocytes and the subsequent development of ischemia and infarction.<\/p>\n

Pathophysiology of MI includes concept of myocardial supply<\/strong> and demand.<\/strong><\/p>\n

By reducing the lumen of the coronary arteries –\u00a0\u00a0 by spasm, atherosclerosis, aortitis, arterial thrombi, aortic stenosis –\u00a0 limits appropriate increases in perfusion when the demand for flow is augmented, as occurs during exertion or excitement.<\/p>\n

The major determinants of myocardial oxygen demand (MVO2<\/sub>) are heart rate, myocardial contractility, and myocardial wall tension (stress).<\/p>\n

Not infrequently, two or more causes of ischemia\u00a0 can coexist.<\/p>\n

Pathology of Coronary Atherosclerosis
\n<\/strong>Epicardial coronary arteries are the major site of atherosclerotic disease. The risk factors\u00a0 leads to inappropriate constriction, luminal thrombus formation, and abnormal interactions with blood leukocytes, especially monocytes, and platelets. Monocyte interaction ultimately results in the subintimal collections of fat, smooth-muscle cells, fibroblasts, and intercellular matrix – atherosclerotic plaques, which develop at irregular rates\u00a0 of the epicardial coronary tree.<\/p>\n

If\u00a0 the diameter of an epicardial artery\u00a0 reduces by 50%, there is a limitation on the ability to increase flow to meet increased myocardial demand. When\u00a0\u00a0 reduced by ~80%, blood flow at rest may be reduced, and further minor decreases\u00a0 can reduce coronary flow dramatically and cause myocardial ischemia.<\/p>\n

The pathogenesis can include:
\n<\/strong>Occlusive intracoronary thrombus – a thrombus overlying an ulcerated or fissured stenotic plaque causes 90% of transmural acute myocardial infarctions.<\/p>\n

Vasospasm – with or without coronary atherosclerosis and possible association with platelet aggregation.<\/p>\n

Emboli – from left sided mural thrombosis, vegetative endocarditis, or paradoxic emboli from the right side of heart through a patent foramen ovale.<\/p>\n

The gross morphologic appearance<\/strong> include:
\n<\/strong>Transmural infarct – involving the entire thickness of the left ventricular wall from endocardium to epicardium, usually the anterior free wall and posterior free wall and septum with extension into the RV wall in 15-30%. Isolated infarcts of RV and right atrium are extremely rare.<\/p>\n

Subendocardial infarct – multifocal areas of necrosis confined to the inner 1\/3-1\/2 of the left ventricular wall.<\/p>\n

Cardiovascular Disease Classification <\/strong><\/p>\n\n\n\n
\n
\n\n\n\n\n\n\n\n\n
Class<\/strong><\/td>\nNew York Heart Association Functional Classification<\/strong><\/td>\nCanadian Cardiovascular Society Functional Classification<\/strong><\/td>\n<\/tr>\n<\/thead>\n
I<\/strong><\/td>\nPatients have cardiac disease but without<\/em> the resulting limitations<\/em> of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea, or anginal pain.<\/td>\nOrdinary physical activity, such as walking and climbing stairs, does not cause angina<\/em>. Angina present with strenuous or rapid or prolonged exertion at work or recreation.<\/td>\n<\/tr>\n
II<\/strong><\/td>\nPatients have cardiac disease resulting in slight limitation<\/em> of physical activity. They are comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea, or anginal pain.<\/td>\nSlight limitation<\/em> of ordinary activity. Walking or climbing stairs rapidly, walking uphill, walking or stair climbing after meals, in cold, or when under emotional stress or only during the few hours after awakening. Walking more than two blocks on the level and climbing more than one flight of stairs at a normal pace and in normal conditions.<\/td>\n<\/tr>\n
III<\/strong><\/td>\nPatients have cardiac disease resulting in marked limitation<\/em> of physical activity. They are comfortable at rest. Less than ordinary physical activity causes fatigue, palpitation, dyspnea, or anginal pain.<\/td>\nMarked limitation<\/em> of ordinary physical activity. Walking one to two blocks on the level and climbing more than one flight of stairs in normal conditions.<\/td>\n<\/tr>\n
IV<\/strong><\/td>\nPatients have cardiac disease resulting in inability<\/em> to carry on any physical activity without discomfort. Symptoms of cardiac insufficiency or of the anginal syndrome may be present even at rest. If any physical activity is undertaken, discomfort is increased.<\/td>\nInability<\/em> to carry on any physical activity without discomfort\u2014anginal syndrome may be present at rest.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n

 <\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n

By zone
\n<\/strong>Depending on the location of the obstruction, different zones of the heart can become injured –\u00a0 anterior, inferior, lateral, apical, septal, posterior, and right-ventricular infarctions (and combinations).<\/p>\n