Cardiac rehabilitation is a medically supervised individualized program designed to improve the quality of life in terms of physical, mental, spiritual and social functioning after a cardiac event. The final goal is to stabilize, slow and when possible to reverse the progression of cardiovascular disease, reducing the possibilities of another cardiac event or early death. Rehabilitation should start as soon as the patient is medically stable. This concept is already established in developed countries but is yet to gain momentum in developing countries including India.

Today, Homoeopathy has achieved its due place in the medical fraternity. It is also seriously attempting to develop itself on scientific lines so as to shoulder its responsibility of catering the Sick in this era of fast changing disease scenario. Apart from its domain of holistic care, it has proved effective in managing cases where advanced pathological changes have effectuated. Although, technological advances have enabled us to precisely localize pathologies, yet the cure for many such disorders remains a dream. It is here that scientific homoeopathy is playing a vital role. Today, an inter-disciplinary approach is the need of the hour. It requires an understanding of the separate contributions made by other disciplines within the ambits of their fundamentals and the integration of that information into a unified whole. This shall reflect on our services to our patients.

The National Academy of Homoeopathy, India is committed to the propagation and advancement of Scientific Homoeopathy. It has already taken a leap towards this goal of Cardiac rehabilitation by establishing a separate department of homoeopathic cardiology in 2004 at Nagpur. Our cardiac rehab program entitled “Dil Ki Seva (A)Dil Se” includes:

1. A detailed history is taken as soon as the patient registers. It includes the causation, onset, modalities, symptoms of heart disease, life-space, mental state (before and after the cardiac event), physical generals and their alterations, past, personal and family history.

2. Initially, if the patient is symptomatic, palliative homoeopathic remedies are used. Once settled then the patient is prepared to receive Constitutional Homoeopathic treatment.                                                                                                                                 
3. Counseling the patient and care takers so that they can understand how homoeopathy can help them to manage the disease process and the patient.                  

                   
4. Beginning an individualized structured exercise program      

                                         
5. Diet planning - increased intake of fibers, reduction in saturated fats, change of cooking oil to sunflower or safflower; and reduction of quantum of common salt.

6. Helping the patient modify maintaining factors of heart disorders as mental stress, smoking, alcoholism, other addictions, physical inactivity, obesity, etc.    

                    
7. Providing vocational guidance to enable the patient to return to work. Account is taken of the type of work, the environment and patient’s psychological state.    

                           
8. Supplying information on physical and sexual limitations      

                                        
9. Lending emotional support to tackle depression (42%: our centre) and anxiety (31%: our centre) that are the most frequent accompaniment of any heart disease. 

                 
10. Educating the patient that almost everyone with heart disease can benefit from some type of cardiac rehabilitation. No one is too old or too young and emphasizing that the most important person in the rehabilitation team is the patient. Patients should be encouraged to take charge of their own recovery.      

                                                      
11. Underlining the fact that feedback is an important requirement for deciding the correctness of the first prescription, to decide the second prescription, potency selection and other auxillary measures that are adopted for management. It should be in the form of a daily dairy or record book.

In our experience, the long-term success of any such program is directly related to patient compliance. Evidence suggests that such a holistic approach is the only sure way that benefits patients. And those who quit smoking and tobacco significantly reduce their risks of another heart attack, sudden death, stroke and total mortality compared with those who continue to smoke.

We have found that when supervised by a homoeopathic physician, cardiac rehabilitation is helpful to patients with

1.      Angina pectoris and recent myocardial infarct,

2.      Patients who have undergone recent Coronary artery bypass graft surgery or PTCA (Balloon angioplasty) 

3.      Congestive heart failure (stable),

4.      Pacemaker implant candidates for heart blocks,

5.      Heart valve replacements

6.      Persons with peripheral arterial disease,

7.      Patients with congenital heart disease who may or may not have had surgery

8.      Heart transplant recipients.(We still have not had any transplant candidates at our centre)

I quote a recent case who had reported at our centre – its an example of how homoeopaths can offer rehabilitation to a cardiac patient.

A 56 years/M, Builder by occupation arrived at our Hospital on 10/1/08 with the complaints of headache and confusion since 1 hour. The wife reported that the patient had come for lunch, slumped over the table, called out but could not say what was wrong. She noticed that his face was twisted and speech was strange.

About 5 months ago patient had first noticed easy tiredness & shortness of breath at his building site and subsequently during routine works. About 3 weeks ago he had sudden palpitations on climbing stairs that recurred at irregular intervals and at rest as well.

On admission - patient was conscious but had a right sided convulsion with urinary incontinence shortly after arrival. He complained of frontal headache and a confused feeling. He was well oriented but had difficulty in finding the right word to reply. H/o Dry Cough < early morning and numb feeling in right hand. No H/o of chest or abdominal pain, ankle swelling, vomiting, dysphagia or haemoptysis.

Ambithermal; Appetite/ Thirst – good, No specific desires or aversions, Stool - 1/day, well formed, soft, h/o Mucus +. Incontinence since the attack. Urine - 5-7 times /day, satisfactory, involuntary dribbling since admission. Sweat –normal. Sleep - 5-6 hours, alert, could not lie on the left side. Dreams - Business and wife’s ill health.

Mentals - Basically apprehensive - business and family, Dominant and Obstinate. A Responsible person but lately loss of self confidence due to financial losses. Memory weak for names.

Past/ H- Rheumatic Fever -1968, Jaundice – 1979, Gastric Ulcer on Endoscopy - 2000. No S/S since last 8 years. Recurrent Bronchitis - 2002.

F/ H - Wife- Rheumatoid A; 2 sons Normal. Mother - HT. Father died – CVE, Sister died aged - heart attack.

Personal/H – Had started as an apprentice at a mechanic and rose to become a well known Builder of Nagpur. Lives with wife and 2 sons. Smokes 30 cigarettes / day. No alcohol or drugs. Hobbies - gardening. Worries about his ability to work and about his wife’s disability. 

O/E -   Well nourished man; thin built, apprehensive. Pulse irregular 140/min, good vol.     BP -130 / 86 mm Hg. Skin, hair, nails – N.               

            RS- Trachea central, Percussion note / Breath sounds – N. Fine Basal crepts +.

            CVS -JVP not raised. No Edema feet. S1 loud. No Opening snap or S3.

                      Apical Pansystolic murmur - axilla (gr2).

            P/A - Mouth – healthy, no abdominal mass; Genitals and rectum - N

            CNS- co-operative, oriented, understands and obeys spoken and written word.

                      Slight delay in finding the right word. Gait - uncertain on legs, but can walk unaided, Rt homonymous hemianopia, slight drooping of right mouth angle.

                      Trunk- Right abd reflexes negative, Limbs- N power/ tone

                      Reflexes-                                   R                                 L

                                    Abd(upper/lower)       -                       +

                                    Biceps                         ++                    +

                                    Triceps                         ++                    +

                                    Knee                            ++                    +

                                    Ankle                          ++                    +

                                    Plantars                       Exten               Flex                            

                        Sensations and co-ordination - N

PROBLEMS                           INVEST                                              TREATMENT

1. MS with MR                       ECG, Xray Ch, CBC,

                                                Electrolytes, ECHO, Card Cath

2. Cardiac Arrythmias             ECG Monitoring                                

3. R Hemiparesis, Dysphasia  Fasting Serum Lipids, EEG                Physiotherapy

                                                                                                            Gelsemium

4. Smoking                                                                                          Psychotherapy

5. H/o Bronchitis                     Lung Function tests

6. Disabled Wife                                                                                 Nursing

7. Constitutional Homoeopathic Remedy – selected after repertorization    

Developments

11/1/08            No convulsions. No S/o CCF.                                             Gels 0/1 3 hrly

10.15 am         ECG- Bifid P waves, other wise NSR                                 Sac Lac

                       CBC / Electrolytes - N

                       Still craving for cigarettes

12/1                 C/o Palpitation & Dyspnoea. Basal Crackles +                   Gels 0/2  2h               

                        Atrial fibrillation confirmed on ECG. HR 130/min     

15/1                 No palpitation. Speech better. LFT - Restrictive pattern    Gels 0/2 TDS         

                        ECHO - MS, MR, fixed calcified valve                             

17/1                 AF controlled. HR 84/min, lungs clear                                 Omit Gels.

                        Neurological signs unchanged. No craving for smoking       SL x 7 days

                        S.Lipids N; HbsAg Neg;                                                        discharged      

                        Advised Cardiac Catheterization

Advised domestic nursing by relatives and report SOS. Patient was subsequently administered Lycopodium 200 1 dose on 25/1/08, and 1M on 6/7/08. He is under follow-up, back to work, has quit smoking and free of palpitations. His Speech is normal and when last seen is asymptomatic. A good example of Cardiac Rehabilitation.

Discussion

1. Physical signs in heart indicate Mitral Stenosis and Regurgitation, probably Rheumatic in origin. Paroxysmal Atrial Fibrillation could account for palpations and irregular pulse. The neurological features point to a lesion in the left cerebral hemisphere probably vascular in origin. In view of the sudden onset, embolism from the Lt atrium is the most likely cause but in this heavy smoker with a F/H of vascular disease; atheroma is an alternative possibility. The effort dyspnoea and bronchitis could result from heavy smoking, from pulmonary congestion due to Mitral disease or combination of the two.

2. Miasmatically - the pathology i.e Rheumatic heart disease - mitral stenosis and regurgitation due to fixed calcified valve represents the end result of Psoro-sycotic (tubercular) phenomenon. It is irreversible with dynamic medications. But episodes of sudden paroxysmal atrial fibrillation are Psoric manifestations, hence a better prognosis.   

3. Gelsimium (Weakness, Paralytic, Generalities; 1418:Kent) was administered for paralysis, aphonia, difficult swallowing, bladder paralysis, nervous affections of smokers.

4. Lycopodium - Most suitable homoeopathic remedy was selected on the following - Right sided remedy, deep seated progressive chronic disease, adapted to intellectually keen but of weak muscular power, loss of self confidence, apprehensive, dominant nature, workaholic – has toiled hard and risen from his own ashes, memory weak especially for names, confused thoughts, inability to find the right word, sees only one half of an object (homonymous hemianopia), thin built.

Infine - Combining all aspects of cardiovascular rehabilitation in appropriate patients improves functional capacity, quality of life, reduces or eliminates maintaining factors and curtails the miasmatic evolution of the sickness. This in turn creates not only a sense of well-being but also optimism about the future. So dear homoeopaths, let us start rehabilitating our cardiac patients!