DEFINITION
Cardiac diseases resulting from myocardial ischaemia (atheroscleotic origin)

CAUSES
" Atherosclerosis
" Congenital abnormalities
" Coronary embolism
" Syphilitic aortitis
" Polyarteritis
" Coronary artery spasm

PATHOLOGY
Characteristic lesion is a plaque (lipid)
The atheromatous plaque narrows the artery. The fibrous cap is prone to fracture. The necrotic core ulcerates & triggers off platelet aggregation and fibrin deposition. This repetitive process leads to complete occlusion.

AETIOLOGICAL FACTORS
" Lipid disorders
" Hypertension
" Obesity
" Family history
" Cigarette smoking
" Physical inactivity
" Mental stress
" Diabetes
" Haemostatic factor

CLINICAL PRESENTATIONS
Angina pectoris
Myocardial infarction

INVESTIGATIONS
" ECG
" Serum enzymes

Early Complications
¢ Disturbances in rate rhythm & conduction
¢ Cardiogenic shock
¢ Ventricular failure
¢ Pulmonary infarction & embolism
¢ Systemic arterial embolism
¢ C V A
¢ Cardiac rupture
¢ Papillary muscle rupture

Late Complication
" Ventricular Aneurysm
" Dressler's Syndrome
" Shoulder Hand Syndrome

Medicines
" a/c medicines to combat MI or angina
" To tackle complications
" In angina, to prevent MI
" To prevent complications
" Post infarction management.

HOMOEOPATHIC ASPECT & MANAGEMENT
In a/c MI little evidences are known to me about a clinical trial with homoeopathic medicines. Role of homoeopathy is more in Preventive Cardiology & Post infarction Management. Homoeopathic medicines can control & prevent causes of IHD.
Atherosclerosis
Treating dyscholestremia can control atherosclerosis. Sumbul, Strophanthus, Strontium Carb, are found to be effective in low or medium potencies for lipid break down. A constitutional support with a remedy given considering the physical & mental make up is always rewarding. Constitutional remedy in higher potencies gives better prognosis. Antimiasmatic drugs can be judiciously used as inter currents when there is a standstill. Syphilinum usually gives better result. Assessment of prognosis should be strictly based on investigation findings. Better go for a lipid profile, since we can advice more applicable diet by knowing the HDL, LDL, VLDL, Triglyceride levels (note that HDL is cardio protective).

So the protocol is
1) Specific drugs for lipid breakdown in low medium potencies in repeated doses.
2) Constitutional drug
3) Anti miasmatic drugs as inter currents.

Once the patient comes to normal limits, a full-charted menu for diet should be given to him. The specific lipid breaking drugs should be given in tapering dose & terminal withdrawal is essential. The final drug (may be constitutional) under which the patient is improved can be withdrawn. In my personal experience, to restart the same drug in 50 millesimal (0/3) OD for long time is prophylactic. Inter current dose of syphilinum1000 once in month gives promising results.
So to maintain the patient in normal cholesterol level the final drug (constitutional) should be continued in 0/3 with syphilinum 1000 one dose once in a month.

Hypertension
Hypertension has no direct relations with IHD. A best selected drug according to symptom similarity or constitution is always a brilliant choice in therapeutics. In atherosclerosis hypertension or any other cardiac malady it is true. Its judicious application, some times with the support of some disease specific drugs become obligatory to manage many conditions having known pathology. In my opinion in all cardiac cases, to workout a treatment strategy considering all these factors before opening the case is a more practical & pragmatic line of management. By this we can adopt more foolproof skills in treating patients.

Homoeopathic management of hypertension itself is a vast topic to be discussed in a seminar. In my experience, for therapeutic purpose patients can be divided to two major groups.

1) Those under allopathic anti hypertensives
2) Unpolluted or freshly detected

In unpolluted cases you can select any drug according to its homeopathicity. Many doctors claim miraculous cures with drugs that are seemingly not cardioselective. No question of appeal in these cures when the medicine given is grounded on strictest symptom similarity. But when the case is spoiled with prolonged use of beta-blockers, calcium channel blockers, ACE inhibitors etc. it becomes difficult to control hypertension. A series of drugs in succession are needed to battle with it. Patient remaining normotensive for a considerable period, after the withdrawal of the allopathic medicine doesn't indicate favorable action of homoeopathic medicine. Many patients remain normotensive for long time after withdrawal of the allopathic medicine, even without any other medication. So we will have to follow him for at least six weeks with intermittent episodes of non-medication (or placebo therapy). The BP may shoot up at any such episode so anticipate it and warn the patient for premonitory S/S. Along with the symptomatically selected drugs some cardioselective drugs (like Rauwolfia, Allium sativa, Passiflora, B.mur, Adrenaline, Belladonna, Glonoine, Gelsimium, Pituitary, Adonis etc.) are also needed to manage these polluted cases. Some drugs have antidotal properties against anti hypertensive allopathic medicines. So they are preferable to open the case. Because of these perplex situations, I believe a protocol is indispensable for the foolproof administration of drugs.

The protocol is
1) Specific drug to neutralize the allopathic medicine.
2) Anti hypertensive Q to titrate BP
3) Constitutional Medicine
4) Any medicine matching a/c symptoms

In the specifics Belladonna 1000 or high is found to be effective in patients under nifidipine. Mercsol has proved to remove bad effects of -blockers especially Atenolol. Nuxvom is always a good starting remedy usually in 1000 potency.This strategy can be used when patient is normotensive more moderately hypertensive but taking allopathy.

If the patient is having high BP a low potency or Q must be started to titrate it. Rauwolfia, Allium sativa, Passiflora, B.mur, Adrenaline, are good. Rauwolfia & Allium sativa could be alternated in high BP. A well-selected constitutional medicine in high potency must be given at regular intervals (say once in a fortnight). Any medicine matching a/c symptoms, this means, say a patient with a headache of spigelia. No doubt it must be given. Then the line becomes the constitutional medicine in high potency at longer intervals & a/c medicine frequently (say spigelia200 /TDS). The reduction of dosage of all should be with monitoring of BP. Usually the a/c symptom subsides with 4th protocol & we must continue the constitutional medicine at still long interval. If he remains normotensive for at least one month start 0/3 of constitutional medicine. Continue it for one year.
Obesity

Constitutional treatment with remedies like Calcaria carb, or other drugs like Phytolacca are effective. Maintain weight chart for proper prognosis. Advice low calorie diet.
Family history is a non-modifiable factor. Risk factors like cigarette smoking, mental stress, physical inactivity, diabetes etc. can be modified by proper advice and medication.

Angina pectoris
Many medicines are described in text books. Amyl nitrosum, Lacteroductus, Glonoine, Kalmia, Bryonia etc. are some of them. Many doctors claim marvelous cures. Sub lingual application of Amyl nitrosum in some cases relived. These trials are not dependable since many anginas are hysterical. For all practical purposes, differentiating acute angina on minute symptomatology for a homoeopathic prescription is virtually impossible in the hyper a/c stage of chest pain. The only solution is, clinical trial of these group of drugs in known coronary insufficiency patients with exercise tracing of ECG (TMT). The changes in serial ECG s can reveal which one can increase coronary circulation or improve exercise tolerance or which can reduce myocardial oxygen demand. Such an experiment is yet to be done.
In a/c myocardial infarction, I don't have any experience & no authentic work published yet in homoeopathy.

POST INFARCTION MANAGEMENT.
" Prevention & treatment of complications
" Tackle complications
A)a/c
B)c/c
" Control of BP
" Dietary regulation
" Moderate exercise
We have little adventures in therapeutics of the immediate post infarction management due to the lack of ICCU. Pulmonary embolism was a major risk factor (3% death) twenty years back. Since early ambulation is the dictum nowadays no such incidence. Apis is said to prevent deep vein thrombosis thus preventing pulmonary embolism. So you can try a dose Apis mel in a patient resuscitating form MI. For long term treatment you can follow steps given above. More details in next issue.

MIASMATIC BACKGROUND
In a/c MI all the 4 miasms (psora, syphilis, and sycosis & pseudo psora) come into play.
The angina is psoric, the changes in coronary vessels are both syphilitic & sycotic.


Contact : Dr.V.S.Ampadi, Ampadi Gardens, Vallikeezhu, Kollam-3
 Ph:0474-2795520, 3090604, 3104842 Mobile 94474-30666 E-mail drampadi@sancharnet.in

For last 10 years I have been doing research in the treatment of cardiac cases with homoeopathic drugs. Patients from allover India are consulting me for the same. More than 15 paper-presentations on different topics under cardiology, in various conferences conducted by medical & allied institutions, are already in my account. I had paper in the 'National Conference on Ischemic Heart Diseases' held at Cochin, regarding the homoeopathic aspects of IHD. All the three major Homoeopathic Medical Colleges (Govt Homoeopathic Medical College Trivandrum, Govt Homoeopathic Medical College Kozhikkodu, Athurasramam Homoeopathic Medical College Kottaym) already conducted continuing medical education programs on cardiology with me. An exclusive homoeopathic clinic for cardiac cases is going to begin from

Again I was a columnist in Homoeopathic Medical Panorama, an internationally reputed magazine as 'News from the cardiology clinic'.