Case Studies 23 : Case of Dextrocadia and ASD
A boy aged 1½ year came to me with some congenital heart complaint. He was dull sitting on mother lap resting with no much activity. His lips and hands appeared bluish. He was breathless and listless. He was dark in complexion and constantly rubbing his eyes. He was carried by mother when entering OPD as he couldn’t walk inspite of being 11/2 year old.
This is a very challenging case of a 1½year old boy diagnosed as a case of Dextrocardia, Large Primary Atrial Septal Defect, Situs Solitus and Pulmonary Atresia, Single AV valve.
Since he was born, all his milestones were delayed. He suffered from recurrent dry cough and breathlessness. He could not play like other children of his age as he would get breathless on slightest exertion.
He couldn’t walk or stand even though he was 1½years old. He used to drag himself on his buttocks. Basically, his overall growth was not appropriate according to his age.
His parents due to lack of education kept neglecting all this, till they started noticing blueness of skin and nails, which was prominent.
At this point of time, they consulted many physicians and specialists and his diagnosis was made.
He was advised immediate surgery but his parents were unwilling for it. Therefore, their family physician told them to drag on the child’s life as it is, as long as he survives.
This was the time when they heard about Homoeopathy and decided to give it a chance.
Dextrocardia...
Dextrocardia is a congenital defect in which the heart is situated on the right side of the body. There are two main types of dextrocardia, dextrocardia of embryonic arrest and dextrocardia situs inversus. Dextrocardia situs inversus is further divided.
Atrial septal defect (ASD)...
ASD is a form of congenital heart defect that enables blood flow between the left and right atria via the inter atrial septum. If there is a defect in this septum, it is possible for blood to travel from the left side of the heart to the right side of the heart, or vice versa. This results in the mixing of arterial and venous blood. This mixture of blood may or may not result in what is known as a "shunt". The amount of shunting present, if any, dictates hemodynamic significance. A "right-to-left-shunt" typically poses the more dangerous scenario.
Complications of an uncorrected secundum ASD include pulmonary hypertension, right-sided heart failure, atrial fibrillation or flutter, stroke, and Eisenmeger's syndrome.
Pulmonary atresia...
Pulmonary atresia is a congenital malformation of the pulmonary valve in which the valve orifice fails to develop.
The valve is completely closed thereby obstructing the outflow of blood from the heart to the lungs.
Once the baby is born its lungs must now provide the oxygen needed for survival, but with Pulmonary atresia there is no opening on the pulmonary valve for blood to get to the lungs and become oxygenated and the only source of pulmonary blood flow is a patent ductus arteriosus. Due to this, the newborn baby is blue in color and pulmonary atresia can usually be diagnosed within hours or minutes after birth.
Prognosis...
The outcome varies for every child. If the condition is left uncorrected it may be fatal. If uncorrected, babies with this type of congenital heart disease may only survive for the first few days of life while the fetal shunts between left and right circulations remain patent.
Investigations:-
2-D Echo :
- Dextocardia.
- Large 1ºASD.
- Single AV valve.
- Situs Solitus.
- LV is very small and Hypoplastic.
- RV large and Hypertrophied.
- Pulmonary Atresia.
- LPA is very large.
- RPA could not be seen very well.
Chief/Complaint:-
1. Breathlessness off & on since birth.
< Slight walking. > Rest.
< Exertion.
2. Weak and flabby muscles of lower limb.
3. Cough off & on since birth.
- Dry cough.
< Evening. > Warm application.
< Night especially 10 pm.
4. Cold & Coryza since 3-4 days.
- Greenish – yellow thick discharge.
< Change of weather. > Warm application.
5. Not gaining weight in accordance with height & age.
6. Delayed milestones.
- Inability to walk.
Past History:-
- H/o F.T.N.D.
Family History:-
Father : Healthy.
Mother : Healthy.
Personal History:
Appetite : Good.
Desire : Milk+++ / Rice / Chocolate / Biscuits /Sweets / Indigestible things-Clay/ Mother’s Milk.
Thirst : S.Q.L.I., Thirstless.
Tongue : Moist, Bluish. Habit of protruding tongue.
Mouth : Dribbling of saliva.
Lips : Cyanosis of lips.
Stools : Twice daily.
Extremities : Weakness in lower limbs Flabbiness of muscles of lower limbs.
Perspiration : Scanty. On head especially forehead. < Sleep during.
Skin : Cyanosis of skin.
Nails : Bluish discoloration. Clubbing.
Sleep : Night-8:30 pm to 7:30 am. Afternoon-1½hour. Sound sleep. Position : Lies on sides or back.
Throws covering during sleep.
Thermals : Towards Hot.
Mind:-
When asked about the nature of the child, his parents provided the following information:
He is mild and calm child. Doesn’t trouble much. Even if he is unwell, he doesn’t trouble anyone for anything.
Even though he can’t stand, he is very active and keeps playing with something or the other. When left alone, he plays with his toys joyfully.
He is very attached to his father.
He loves watching cartoons. He is naughty.
Also he is very inquisitive. If he finds that he is not being able to do something, he tries hard to figure out some way to do it.
He is restless and very active at times he gets headstrong for certain things.
He is a very cheerful child. Doesn’t cry much. He cries only if he is beaten or shouted at or few things done against will.
Totality:-
- Mild & yielding.
- Dullness
- Anger contradiction
- Obstinate
- Towards Hot patient.
- Weakness of lower limbs.
- Desire : Milk / Sweets / Indigestible things.
- < Change of weather.
- < Exertion.
- Delayed Milestones.
- Cyanosis.
- Dry cough.
- Perspiration over forehead < Sleep during.
- Flabby muscles.
- Sleepiness.
- Walk late learning to.
- Delayed milestones
Response:-
Medicine was administered and immediately the child was admitted.
Within 1 month, the child who couldn’t walk in spite of being 1½yr old, started walking.
Cyanosis reduced steadily along with clubbing.
He no more experienced breathlessness on exertion. He eats well. His height and weight is also increasing according to his age. Along with this, his mental development is normal for his age.
Patients of Dextrocardia, ASD and Pulmonary atresia are usually very prone to recurrent infections. But since the time this patient is on Homoeopathic treatment, he has not suffered from any of these.
Only 3 years later he suffered from an attack of fever.
In such patients, any attack of fever or infection can pose a danger to the life of patient.
When the patient was brought to me he appeared almost lifeless.
- He was severely exhausted and cyanosed.
- He was in an extremely drowsy state.
- He had high grade fever and he refused to eat at all. He had even vomited a few times.
- Tongue: Thick white coated.
- Thirstless heat during.
- Thermally: Towards Chilly.
- He was severely breathless and rattling of mucus was heard in the breath sounds. His oxygen saturation was
50-52%. Clinically it was diagnosed as Pneumonia.
Such was the condition of the child that while narrating his complaints his mother was in tears.
He was admitted and considering the acute totality another remedy was administered.
His fever reduced within 1-2 days. Cyanosis also decreased gradually. His overall general condition improved.
His oxygen saturation increased to about 85%. This was a life threatening acute episode which was taken care of successfully with homoeopathy.
After this the regular medicine was continued and patient is doing great carrying his day to day activities,
going to school……