Case Studies 24 : Case of dilated cardiomyopathy and CCF
What else will be more belief strenthening than the cases left to its fate in conventional system of medicine getting treated with Homoeopathy?
It is inspiring to one and all. Isn’t it?
It’s our duty to make the most of this inspiration received, so that each of us gains the courage, confidence and ability to treat such cases.
It is the best way we can serve the humanity. It will be a blessing for the patient if he is cured with no addition to his sufferings.
Let us go through a similar case in which conventional system was helpless.
A young fair chubby looking girl came along with her father for homoeopathic consultation. Just 15 years old looking pallored dull, lethargic with tired face. She had severe breathlessness and inspite of continuous breathing efforts it did not help. The
whole body seemed exhausted. She uttered few words with great difficulty and hence parents continued the conversation.
She was diagnosed to have Global LV Hypokinesia with Dilated Cardiomyopathy. Her reports showed mild Mitral Regurgitation along with Mild Pulmonary, HTN.
Parents were really anxious and tensed as a well known cardiologist from Pune had adviced her a heart transplant .it obviously a very difficult surgical procedure with requirement of advanced surgical theatre.
Pathology…
Dilated cardiomyopathy or DCM is a condition in which the heart becomes weakened and enlarged and cannot pump blood efficiently. The decreased heart function can affect the lungs, liver, and other body systems.
Although in many cases no cause (etiology) is apparent, dilated cardiomyopathy is probably the result of damage to the myocardium produced by a variety of toxic, metabolic, or infectious agents. It may be due to fibrous change of the myocardium from
a previous myocardial infarction. Or, it may be the late sequelae of acute viral myocarditis, such as with Coxsackie B virus and other enteroviruses, possibly mediated through an immunologic mechanism. Autoimmune mechanisms are also suggested as a
cause for dilated cardiomyopathy. Genetic testing can be important.
Occurring mostly in adults 20 to 60. It affects the heart's ventricles and atria, the lower and upper chambers of the heart, respectively.
Frequently the disease starts in the left ventricle, the heart's main pumping chamber. The heart muscle begins to dilate, meaning it stretches and becomes thinner. As the heart chambers dilate, the heart muscle doesn't contract normally and cannot pump
blood very well. As the heart becomes weaker heart failure occur. Consequently, The inside of the chamber enlarges. The problem often spreads to the right ventricle and then to the atria.
The heart muscle has reduced contractility. This produces a reduction in cardiac output, which then becomes inadequate to meet the peripheral demands of the body. The 4 primary determinants of left ventricular (LV) performance are generally altered as
follows: (1) There is an intrinsic decrease in muscle contractility. (2) Preload or left atrial filling pressure is increased, resulting in pulmonary congestion and dyspnea. (3) Although systemic blood pressure is often reduced, there is an increase in systemic
vascular resistance (afterload), which can further reduce cardiac output. (4) Heart rate is generally increased due to sympathetic tone and circulating catecholamines.
Common symptoms of heart failure include shortness of breath, fatigue and swelling of the ankles, feet, legs, abdomen and veins in the neck. Gross edema and ascites occur much later,
Death is due to either congestive heart failure or ventricular tachy- or bradyarrhythmias.
Heart transplant is the last alternative.
The major survival gains are limited to the first 6 to 12 months, with a long-term attrition rate of 3.4 percent per year thereafter, remaining largely unchanged. The improvement is probably larger than it appears, since the risk profile of recipients and the age of donors
continue to increase.
Determinants of prognosis - A number of factors in the recipient and donor are associated with a worse prognosis post-transplantation.
Approximately 85 to 90 percent of heart transplant patients are living one year after their surgery, with an annual death rate of approximately 4 percent thereafter. The three-year survival approaches 75 percent.
Her case history is as follows :
Complaints started with sudden abdominal pain. Considering it as a routine, conventional treatment was given, but it gave no relief. In next 1to2 days she got frequent vomiting. Medicines served to be of hardly any help. She was then advised for an Ultra - Sonography. It revealed Hepatomegaly. Considering this she was advised to be taken to a multispecialty hospital and to be investigated.
She was taken a hospital in Ahmed Nagar. Here she was investigated.
2decho reports revealed a Severe Dilated Cardiomyopathy with ejection fraction of 35%.treatment was started but her condition further deteriorated and she had to be shifted to tertiary hospital in Pune. She was kept in I.C.U. for 15 days. Condition seemed better and hence she was discharged in next 4-5days.
She was well for few days, where later condition deteriorated when she resumed college. There was rise in breathlessness, frequent fainting episodes on exertion loss of appetite….
Physician for this condition had no medical treatment and they informed that this condition itself has no treatment and had advised for heart transplant.
The solution given was something impossible for a common man to think for.
Investigations :-
2 Echo :
- Dilated LV.
- Global LV Hypokinesia.
- LVEF 30%
- Mild Mitral regurgitation.
- Moderate Pulmonary HTN.
- RVSP 57 mmHg.
3D Echo, Color Doppler :
- Dilated Cardiomyopathy.
- Improved LV systolic function.
- LVEF 35%
- Mild Pulmonary HTN.
- RVSP 42 mmHg.
Chief/Complaints :-
1. Breathlessness on exertion since 2 yrs.
- Gradual onset of complaint.
- Feels very tired, fatigued.
- Breathless on walking even 1 km.
- Duration : 10-15 mins.
< Walking fast. > Walking slowly.
< Lying on back and abdomen. > Lying on Lt. side.
< Walking for 1 km. > Rest.
< Ascending stairs. > Open air.
< Closed room. > Fanning.
< Bending forward. > Bending head backward.
< Lying on Rt. Side. > Sitting - leaning on a wall.
2. Vertigo on & off since 6-7 months.
- Sudden onset.
- Duration : 30 mins to 1 hr.
- Gets dizzy, darkness before eyes and sometimes collapses i.e. faints for 3-5 mins.
- Heaviness of head.
< Sudden noise. > Sitting.
< Walking for long distance . > Sleep after.
< Walking fast. > Rest.
< When in haste. > Lying on Lt. side.
< Sun heat.
< When somebody shouts.
< If awakened suddenly from sleep.
< Standing for long time not more than 15 mins.
3. Recurrent cold and coryza on & off since 3 yrs.
- Sudden onset.
- Starts in the morning at 8:00 am → nose blockage → pain in throat (pricking sensation) → running nose → watery, transparent
discharges. Continuous for 2-3 days → alternate with nose blockage / watery discharge.
- Hoarseness of voice.
- Watery discharged from eyes.
- Sneezing 2-3 times loudly. Not frequently.
- Ears get blocked.
4. Oedema on both upper and lower limbs.
- Heaviness.
< Walking. > Slow walk.
< Morning 9 am to 1 pm. > Rubbing.
< Stretching.
5. Sleeplessness since 8 days agg.
- H/o Sleeplessness since 6 months.
- Patient was taking sleeping pills since 6 months; stopped since 8 days.
- Once had taken 5 tablets at night – very drowsy next day. (suicidal attempt)
6. Feels very tired –weary, less energetic since 2 yrs.
- No desire to do anything.
- Gets very irritated.
Past History :-
- H/o Delivery at the 8 th month as her mother was having Low BP.
- Birth weight 2 kg.
- Cried late (?)
- Didn’t get mother’s milk as mother was suffering from TB of Lungs.
- External feeding – Lactogen.
- Delayed milestones by 1-2 months only.
- H/o Nausea & vomiting on 3 years. (Did not improve for 15-20 days)
- Heart problem detected about 30 days after that.
Family History :-
Father : Dust allergy.
Mother : Koch’s, Low B.P.
Grand Father : HTN, D.M, Heart problem.
Grand Mother : HTN, D.M, Heart problem.
Physical Generals :-
- Diet - Veg.
- Desire - Spicy, Oily, Fried food, Fast food,
- Sour + , Salty.
- Aversion - Fruits, Green Vegetables, Bitter.
- Food< - Spicy, Oily < Acidity, pain in abdomen.
- Tongue - Moist.
- Gums - Occasional bleeding.
- Thirst - Thirsty ++ .
- Throat - Sore throat; Hoarseness.
< Drinking water. > Hot soup.
< Cold drinks. > Gurgling.
< Drinking hot water.
< Ice cream.
- Chest - Retrosternal burning after having food
Pain in epigastric region.
< After having food. > Cold drink.
< Spicy food.
< Morning 11:00 am to 1:00 pm.
- Abdomen - Distended, heaviness of abdomen.
< Spicy food. > Sitting with support.
< Rich food.
- Bowels - Constipation d/t sleep deprived. Regular 1/day.
- Urine - Normal.
- Perspiration - Profuse on waking on face, back, axilla. Can’t tolerate heat, Sun.
- Sleep - Sleeplessness up to 3 a.m. Sleeps after 3 a.m. to 8:00 a.m. Daytime : 2-3 hrs. Position : Lying on Lt. side.
Grinding teeth during sleep.
- Dreams - Of future, of doctor (about ambition) as she got a trophy when she became a doctor in school competition.
- Thermally - Towards Hot.
MIND:-
1. Tell me about your family?
We are 5 members in the family; mother, father and a younger sister. I share a very
good relation with all family members. Financially we are average.
2. Tell me about your education ?
I have completed my 11 th standard. I was always good in studies. But in std. 10 th I
scored less due to my health problems. I couldn’t attend school and directly appeared
for the exams. I feel bad about it.
I want to become a doctor so that I can cure the sick people.
3. Tell me about your nature?
I don’t get angry easily.
Her mother added “She is mild in nature and very sensitive. Weeps immediately if
scolded. Cannot tolerate scolding. She is pampered and gets angry when things do not
happen according to her will.
Anger is never expressed violently but is by keeping quiet. She is straight forward
and takes good care of her sister.
She likes helping others and is sensitive when sees someone in difficulty.
She is matured and understands well if there is some problem in the house.
She is close to both of us.”
4. What are your hobbies?
I love painting and sketching.
Mother added, “She is very good in drawing. There is lot of neatness in her work.”
I like drawing cartoons. Along with this I like to watch T.V., listen to songs and sing.
5. Any fears, bad incidences or tensions?
I feel I will not be able to do the given work properly. If I don’t do it properly I will
be scolded, which will again affect my confidence.
I do fear darkness when I am alone.
I feel tensed about the disease. What will be my future as I can’t study?
I don’t have many close friends. I had few but since my illness I am not much in
touch. Even they don’t miss me now. They rarely call me; they don’t invite me if
there is any party. I feel they avoid me. I feel lonely. At times I have extreme
thoughts as to no desire to live.
Mother added “She has tried once eating 5-6 sleeping pills in frustration.”(Added
when alone)
My Observation :-
- Anxious.
- Creative.
Totality :-
- Affectionate.
- Creative / Artistic.
- Anxiety failure.
- Anxiety pressure on chest.
- Confidence want of.
- Suicidal disposition
- Heart dilatation.
- Breathlessness
- < Exertion.
- > Sitting
- Desire and < Spicy, oily.
- Oedema extremities.
- Fanning desire.
- Open air desire.
- Thermal : Towards Hot.
- Miasm : Syphilitic.
Response :-
She was admitted after consultation. Initially Carcinosin 200 was given. It didn’t give
much relief; hence, medicine was changed after 3 days.
It took 15 days to notice a considerable relief. In initial days there was reduction in
breathlessness and blood pressure was under control. There was persistent vertigo.
Constant improvement was noticed. In 15 days she could sit comfortably i.e.
breathlessness had considerably reduced.
She had a good sleep after long days. There was no requirement for sleeping pills.
Vertigo had completely stopped.
She was allowed to go out for walk after 20-25 days. She could tolerate it well. In initial
few days she had to take a break of 5min in walk of say kilometer. Later even that was
not required. She could ascend and descend the steps comfortably.
She added “the improvement not seen in last 2yrs with allopathic medicines was notices
in this one month of homoeopathic treatment.
Also I feel fresh and positive. I don’t take sleeping pills and get a good refreshing natural
sleep.
A repeat 2D-Echo showed drastic improvement:
Its almost 5 years she is doing well with all her activities normal.
Latest reports 2017 EF is 45%